Basic Information
| Provider Information | |||||||||
| NPI: | 1225230915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POURCIAU | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 N DUNLAP ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381032802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012874825 | ||||||||
| FaxNumber: | 9012874820 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 N DUNLAP ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381054625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012877337 | ||||||||
| FaxNumber: | 9012875506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NP0225X | N9400 | TX | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207NP0225X | 56555 | TN | Y | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology |
No ID Information.