Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 35504 | TN |
NPI | 1326004128 |
---|---|
Provider Name | Dr. Louis J Magnotti |
First Address | Memphis, TN 38105-5105 |
Second Address | Memphis, TN 38103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3325997 | (05) | TN |
H67753 | (02) |