Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | PENDING | TN |
N | 2086S0122X | Plastic and Reconstructive Surgery | T1125 | IA |
NPI | 1285908509 |
---|---|
Provider Name | Anas Eid |
First Address | Memphis, TN 38119-0809 |
Second Address | Memphis, TN 38119-0809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2012 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FE2949014 | DEA (01) | IA |