Organization
MEMPHIS PEDIATRIC GASTROENTEROLOGY & HEPATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN L REESE (OFFICE MANAGER)
(901) 458-4282
Entity
Organization
Contact information
Practice address
806 ESTATE PL, MEMPHIS, TN 38120-0600
(901) 287-4017
(901) 287-4013
Mailing address
2670 UNION AVENUE EXT, SUITE 1220, MEMPHIS, TN 38112-4426
(901) 458-4282
(901) 458-8192
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0048573
BLUE CROSS GROUP ID
TN
05
—
09010528
—
MS
01
—
3387689
HEALTHSOURCE
TN
05
—
3387689
—
TN
01
—
84107
ARK FIRST SOURCE
AR
Enumeration date
11/20/2006
Last updated
08/22/2020
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