Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K2828 | TX |
Y | 207QS0010X | Family Doctor - Sports Medicine | 62514 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | K2828 | TX |
NPI | 1295730786 |
---|---|
Provider Name | Christopher Anthony Witherspoon |
First Address | Memphis, TN 38120-9401 |
Second Address | Memphis, TN 38120-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168601601 | (05) | TX |
168601602 | (05) | TX |
168601605 | (05) | TX |
G68234 | (02) |