MEDICARE: DR. YVETTE RANDLE OSWELL MD

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	173000000X	Legal Medicine	MD0000028644	TN
2	207Q00000X	Family Medicine Physician	28644	TN

General Provider Information

NPI Number	:	1629022066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE RANDLE OSWELL MD

Provider Business Mailing Address
First Line	:	5142 STAGE RD
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38134-3164
Country	:	US
Telephone Number	:	901-382-2040
Fax Number	:	901-386-5242

Provider Business Practice Location Address
First Line	:	5142 STAGE RD
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38134-3164
Country	:	US
Telephone Number	:	901-382-2040
Fax Number	:	901-386-5242

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/07/2016

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