Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 24161 | MS |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 53603 | TN |
NPI | 1134171713 |
---|---|
Provider Name | Gregory W Fink |
First Address | Memphis, TN 38148-0001 |
Second Address | Germantown, TN 38138-4933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 19/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01554513 | (05) | MS |
212251001 | (05) | AR |
6054934 | BCBS (01) | TN |
H25009 | (02) | |
Q018208 | (05) | TN |