Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | MD13794 | TN |
Y | 213ES0000X | Sports Medicine | MD13794 | TN |
NPI | 1477671238 |
---|---|
Provider Name | Dr. Eduardo Vargas Cruz |
First Address | Memphis, TN 38133-5078 |
Second Address | Memphis, TN 38133-5078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04465 | (02) | TN |