Individual
GARY NACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
880 MADISON AVE, MEMPHIS, TN 38103-3409
(901) 545-6969
(901) 545-7387
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-7302
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036108353
IL
207R00000X
Internal Medicine Physician
Primary
14813
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00055091
—
MS
05
—
036108353
—
IL
01
—
07215036
BCBS
IL
05
—
187949001
—
AR
05
—
3020124
—
TN
01
—
4300658
BCBS
TN
01
—
IL01CY
JOHN DEERE
IL
Enumeration date
03/10/2006
Last updated
12/17/2015
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