Organization
MED-NET HEALTHCARE AFFILIATES, PC
Active
Other names
PROMEDICA CLINIC, PC / MAX FONER, MD, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MAX FONER M.D. (PRESIDENT, MEDICAL DIRECTOR)
(901) 526-7695
Entity
Organization
Contact information
Practice address
361 N 3RD ST, MEMPHIS, TN 38105-2710
(901) 526-7695
(901) 525-4483
Mailing address
361 N 3RD ST, MEMPHIS, TN 38105-2710
(901) 526-7695
(901) 525-4483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649357062
MEDICARE INDIVIDUAL NPI NUMBER FOR MAX FONER, M.D.
—
01
—
3119555
MEDICARE INDIVIDUAL PTAN NUMBER FOR MAX FONER, M.D.
—
01
—
3389128
MEDICARE GROUP PTAN NUMBER
—
Enumeration date
11/01/2006
Last updated
03/27/2011
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