Provider Demographics
NPI:1063638104
Name:FLETCHER, DANIEL TRUMAN JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TRUMAN
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUTIE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-701-2400
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7706207X00000X, 207XS0106X
TN43438207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507098Medicaid
MS620819926OtherBCBS
TN9119125OtherAETNA
TN620819926OtherCIGNA
MS7187860Medicaid
TNP00624372OtherRAILROAD MEDICARE
AR110318002Medicaid
TN620819926OtherAETNA
MS00171710Medicaid
TN3371161Medicaid
TN4174181OtherBCBS
TN620819926OtherTRICARE
TN0546047OtherCIGNA
AR110318002Medicaid
TN0723280001Medicare NSC