MEDICARE: DR. DAVID P FANG 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	2085R0202X	Diagnostic Radiology Physician	36117	TN
2	2085R0204X	Vascular & Interventional Radiology Physician	17208	MS
3	2085R0204X	Vascular & Interventional Radiology Physician	36117	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952304107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID P FANG MD

Provider Business Mailing Address
First Line	:	6401 POPLAR AVE STE 220
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4884
Country	:	US
Telephone Number	:	901-237-7698
Fax Number	:	901-682-9747

Provider Business Practice Location Address
First Line	:	6401 POPLAR AVE STE 505
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4808
Country	:	US
Telephone Number	:	901-685-2696
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/17/2023

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Directions to “ DR. DAVID P FANG MD” Practice Location

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