Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | MD6594 | TN |
N | 207ND0900X | Dermatopathologist | MD6594 | TN |
N | 207NS0135X | Procedural Dermatology | MD6594 | TN |
NPI | 1275506404 |
---|---|
Provider Name | Mr. Rex Allen Amonette |
First Address | Memphis, TN 38104-6727 |
Second Address | Memphis, TN 38104-6727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3151813 | (05) | TN |
B02373 | (02) |