Basic Information
| Provider Information | |||||||||
| NPI: | 1134171713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FINK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 960 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017612470 | ||||||||
| FaxNumber: | 9017674898 | ||||||||
| Practice Location | |||||||||
| Address1: | 7655 POPLAR AVE STE 350 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381384933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017612470 | ||||||||
| FaxNumber: | 9017674898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 53603 | TN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 24161 | MS | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | Q018208 | 05 | TN | MEDICAID | 6054934 | 01 | TN | BCBS | OTHER | 01554513 | 05 | MS | MEDICAID | 212251001 | 05 | AR | MEDICAID |