Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 53440 | TN |
N | 207Q00000X | Family Doctor | E-7267 | AR |
N | 207Q00000X | Family Doctor | MD444907 | PA |
Y | 207SG0201X | Clinical Genetics (M.D.) | 53440 | TN |
N | 207SG0201X | Clinical Genetics (M.D.) | E-7267 | AR |
N | 207SG0201X | Clinical Genetics (M.D.) | MD444907 | PA |
NPI | 1861629172 |
---|---|
Provider Name | Henry Joel Mroczkowski |
First Address | Memphis, TN 38103-2802 |
Second Address | Memphis, TN 38105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 05/07/2018 |