Basic Information
| Provider Information | |||||||||
| NPI: | 1285645275 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE ENDOCRINE CLINIC, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5659 S REX RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017633636 | ||||||||
| FaxNumber: | 9012553636 | ||||||||
| Practice Location | |||||||||
| Address1: | 5659 S REX RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017633636 | ||||||||
| FaxNumber: | 9012553636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9017633636 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CE7490 | 01 | MEDICARE RAILROAD | OTHER |