Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 27186 | TN |
NPI | 1083671168 |
---|---|
Provider Name | Dr. John P Devincenzo |
First Address | Memphis, TN 38105-5105 |
Second Address | Memphis, TN 38132-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3096501 | (05) | TN |
G17876 | (02) |