1750350757 NPI number — BERNADETTE A DEOGAYGAY M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750350757 NPI number — BERNADETTE A DEOGAYGAY M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DEOGAYGAY

Provider First Name:

BERNADETTE

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1750350757

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/12/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 752743

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MEMPHIS

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

38175-2743

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

901-565-0244

Provider Business Mailing Address Fax Number:

901-565-0616

Provider First Line Business Practice Location Address:

6490 MOUNT MORIAH ROAD EXT

Provider Second Line Business Practice Location Address:

SUITE 200

Provider Business Practice Location Address City Name:

MEMPHIS

Provider Business Practice Location Address State Name:

TN

Provider Business Practice Location Address Postal Code:

38115-3729

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

901-565-0244

Provider Business Practice Location Address Fax Number:

901-565-0616

Provider Enumeration Date:

03/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RN0300X , with the licence number:  34588 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RN0300X , with the licence number: E3210 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RN0300X , with the licence number: 14588 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 142433001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 3416199001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4030322 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 055491 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 4030322 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 06170061 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 114248 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 21734 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 5M199 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 3859242 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".