Individual
JACOB KRIEDERMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-7100
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5582
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
3425
TN
207P00000X
Emergency Medicine Physician
T-2975
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01150325
—
MS
Enumeration date
03/23/2015
Last updated
08/08/2018
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