Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 00000 | TN |
NPI | 1558034280 |
---|---|
Provider Name | Dr. Petro Boshra Hakeem Yousef |
First Address | Memphis, TN 38104-6847 |
Second Address | Memphis, TN 38104-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |