MEDICARE: DR. TYRONE TEAKO DAVIS D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	652	TN

General Provider Information

NPI Number	:	1467449041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYRONE TEAKO DAVIS D.P.M.

Provider Business Mailing Address
First Line	:	1204 MADISON AVE
Second Line	:	2
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2226
Country	:	US
Telephone Number	:	901-523-7698
Fax Number	:	901-272-2045

Provider Business Practice Location Address
First Line	:	1204 MADISON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2226
Country	:	US
Telephone Number	:	901-523-7698
Fax Number	:	901-272-2045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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