Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 11170 | TN |
NPI | 1063582278 |
---|---|
Provider Name | Dr. Christine T Mroz |
First Address | Memphis, TN 38119-5217 |
Second Address | Memphis, TN 38119-5217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
316700 | (05) | TN |
B03122 | (02) |