Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 17482 | MS |
N | 2080P0208X | Pediatric Infectious Diseases | 17482 | MS |
NPI | 1457400061 |
---|---|
Provider Name | Dr. Ariel Ramiez Porcalla |
First Address | Memphis, TN 38116-6373 |
Second Address | Memphis, TN 38116-6373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0126088 | (05) | MS |
H68759 | (02) | MS |