Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 19036 | TN |
NPI | 1245242221 |
---|---|
Provider Name | Marva L Souder |
First Address | Memphis, TN 38119-8221 |
Second Address | Memphis, TN 38119-8221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 26/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3047477 | (05) | TN |
E89218 | (02) | TN |