Individual
GUY J PHOTOPULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-8999
Mailing address
877 JEFFERSON AVENUE, PROVIDER ENROLLMENT, MEMPHIS, TN 38103
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
11396
TN
207VX0201X
Gynecologic Oncology Physician
E1662
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507228
—
TN
01
—
4165052
BCBS TN
TN
Enumeration date
07/02/2006
Last updated
01/17/2018
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