Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS2546 | TN |
NPI | 1013905165 |
---|---|
Provider Name | Dr. Isaac Fordjour |
First Address | Memphis, TN 38103-3403 |
Second Address | Memphis, TN 38103-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 24/06/2014 |