Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 38362 | TN |
Y | 207PP0204X | Pediatric Emergency Physician | 38362 | TN |
NPI | 1053311241 |
---|---|
Provider Name | Dr. Anthony C Moretta |
First Address | Memphis, TN 38103-4476 |
Second Address | Memphis, TN 38103-4476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3890839 | (05) | TN |
G78131 | (02) | TN |