Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10869 | TN |
Y | 213EG0000X | General Practice | 10869 | TN |
NPI | 1003384215 |
---|---|
Provider Name | Dr. Mark David Devincenzi |
First Address | Memphis, TN 38134-3812 |
Second Address | Memphis, TN 38134-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |