Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 1274 | TN |
NPI | 1255383386 |
---|---|
Provider Name | Nicholas J. Economides |
First Address | Memphis, TN 38119-5217 |
Second Address | Memphis, TN 38119-5217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 18/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000239823 | ANTHEM BCBS (01) | |
001714145 | MOUNTAIN STATE BCBS (01) | |
240007884 | RR MEDICARE (01) | |
B59463 | (02) |