Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 2012001026 | MO |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 2012001026 | MO |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 41584 | TN |
NPI | 1386668929 |
---|---|
Provider Name | Umar S. Boston |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38103-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 13/01/2017 |