1215930458 NPI number — DR. WAYNE L FURMAN MD

Table of content: DR. WAYNE L FURMAN MD (NPI 1215930458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215930458 NPI number — DR. WAYNE L FURMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FURMAN
Provider First Name:
WAYNE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215930458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
262 DANNY THOMAS PL
Provider Second Line Business Mailing Address:
MS 515
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38105-3678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-595-3006
Provider Business Mailing Address Fax Number:
901-595-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 DANNY THOMAS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105-3678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-595-3006
Provider Business Practice Location Address Fax Number:
901-595-3842
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  14617 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3808896 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 326144190A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527648 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7612991 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1533866 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204895908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507257 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132438001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004431 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 715352 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0030520 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104818491 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64926629 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00118058 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0142086 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200181370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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