Basic Information
| Provider Information | |||||||||
| NPI: | 1285014712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESOUZA | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7875 GROVE CT E APT 11-101 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381383301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475830399 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7424 US HIGHWAY 64 STE 111 | ||||||||
| Address2: | |||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381338937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013723573 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2015 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21172 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | CO412 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME129120 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57359 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.