Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 36683 | TN |
Y | 2080P0210X | Pediatric Nephrologist | 36683 | TN |
NPI | 1275533580 |
---|---|
Provider Name | Noel M Delos Santos |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 06/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3496781 | (05) | TN |
H75221 | (02) | TN |