Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 34128 | TN |
NPI | 1326004177 |
---|---|
Provider Name | Dr. Nosratollah Nezakatgoo |
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 | 21/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3157769 | BC/BS TN (01) | TN |
3852714 | (05) | TN |
H15781 | (02) | TN |