Individual
MR. DEJO VIPRAKASIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1995 HWY 51 SOUTH, SUITE 104, COVINGTON, TN 38019
(901) 476-1135
(901) 476-1136
Mailing address
PO BOX 388, 1995 HWY 51 SOUTH SUITE 104, COVINGTON, TN 38019
(901) 476-1135
(901) 476-1136
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD11008
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007928
BLUE CROSS
TN
05
—
3383546
—
TN
01
—
4031846
AETNA
—
Enumeration date
11/09/2005
Last updated
07/08/2007
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