Mrs. Dallas Jordan Davis Provence
Dermatopathologist
6254 Poplar Ave
Memphis
, Tennessee 38119-4713
Mrs. Dallas Jordan Davis Provence
Dermatopathologist
6254 Poplar Ave
Memphis
, Tennessee 38119-4713
(901) 338-1340
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About
Features
Specialties
- Dermatopathologist
Languages spoken
- English
Location
First Address
- Mrs. Dallas Jordan Davis Provence
- 295 Pandora St
- Memphis, TN
- Zip : 38117-2854
- Phone : (901) 338-1340
Second Address
- Mrs. Dallas Jordan Davis Provence
- 6254 Poplar Ave
- Memphis, TN
- Zip : 38119-4713
- Phone : (901) 624-3333
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Is Mrs. Dallas Jordan Davis Provence a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207ND0900X | Dermatopathologist | 28973 | TN |
National Provider Identifier
| NPI | 1619556230 |
|---|---|
| Provider Name | Mrs. Dallas Jordan Davis Provence |
| First Address | Memphis, TN 38117-2854 |
| Second Address | Memphis, TN 38119-4713 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/04/2021 |
| Last Update Date | 02/04/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.