Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53030 | TN |
Y | 2080P0208X | Pediatric Infectious Diseases | 53030 | TN |
NPI | 1053603811 |
---|---|
Provider Name | Timothy Flerlage |
First Address | Memphis, TN 38163-0001 |
Second Address | Memphis, TN 38163-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 15/07/2020 |