1790727626 NPI number — SETH L YOSER M.D.

Table of content: SETH L YOSER M.D. (NPI 1790727626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790727626 NPI number — SETH L YOSER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOSER
Provider First Name:
SETH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1790727626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1264 WESLEY DR
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38116-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-348-0415
Provider Business Mailing Address Fax Number:
901-348-0419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1264 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-348-0415
Provider Business Practice Location Address Fax Number:
901-348-0419
Provider Enumeration Date:
06/12/2006

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: 207W00000X , with the licence number:  MD0000025588 , 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: 3084098 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00115871 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208206003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3032701 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4410704 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0169183 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051095479 . This is a "BCBS AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126035001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000113848 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000095479 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0840102 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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