Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 32256 | TN |
N | 207RP1001X | Pulmonary Disease | 32256 | TN |
NPI | 1063491280 |
---|---|
Provider Name | Dr. Matthew W Mabie |
First Address | Memphis, TN 38157-0101 |
Second Address | Memphis, TN 38157-0101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H04471 | (02) | TN |