Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 18163 | TN |
NPI | 1023075249 |
---|---|
Provider Name | Mark C Bugnitz |
First Address | Memphis, TN 38101-5135 |
Second Address | Memphis, TN 38103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3028713 | (05) | TN |
3028715 | (02) | |
A99263 | (02) |