Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD024166 | LA |
N | 111NI0900X | Internist | MD024166 | LA |
N | 208000000X | Pediatrician | 024166 | LA |
Y | 2080P0205X | Pediatric Endocrinologist | 47280 | TN |
NPI | 1093807638 |
---|---|
Provider Name | Dr. Alicia Marie Diaz-Thomas |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38105-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 27/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487864 | (05) | LA |
H52029 | (02) | LA |