Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS0000009784 | TN |
NPI | 1902183940 |
---|---|
Provider Name | Dr. Shokoufeh Shahrabi Farahani |
First Address | Memphis, TN 38103-3513 |
Second Address | Memphis, TN 38103-3513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2011 |
Last Update Date | 09/09/2016 |