Individual
NICHOLAS J. ECONOMIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6005 PARK AVE STE 700, MEMPHIS, TN 38119-5217
(901) 255-3003
Mailing address
6005 PARK AVE STE 700, MEMPHIS, TN 38119-5217
(901) 255-3003
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
1274
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000239823
ANTHEM BCBS
—
01
—
001714145
MOUNTAIN STATE BCBS
—
01
—
240007884
RR MEDICARE
—
Enumeration date
05/17/2006
Last updated
08/18/2015
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