Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 20877 | MS |
Y | 207T00000X | Neurosurgeon | 44723 | TN |
N | 207T00000X | Neurosurgeon | 45712 | MN |
NPI | 1013995901 |
---|---|
Provider Name | Todd E Fountain |
First Address | Memphis, TN 38120-2300 |
Second Address | Memphis, TN 38120-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266914500 | (05) | MN |
I01486 | (02) |