MEDICARE: DR. SAMUEL TADIAR VERZOSA 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	207R00000X	Internal Medicine Physician	18346	TN

General Provider Information

NPI Number	:	1730182882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL TADIAR VERZOSA MD

Provider Business Mailing Address
First Line	:	2851 STAGE CENTER DR
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-4679
Country	:	US
Telephone Number	:	901-388-7711
Fax Number	:	901-507-2280

Provider Business Practice Location Address
First Line	:	2851 STAGE CENTER DR
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-4679
Country	:	US
Telephone Number	:	901-388-7711
Fax Number	:	901-507-2280

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/10/2009

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