Provider Demographics
NPI:1073537619
Name:GOSHORN, NEUMON TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:NEUMON
Middle Name:TAYLOR
Last Name:GOSHORN
Suffix:
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 1:1364 CORDOVA CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2200
Mailing Address - Country:US
Mailing Address - Phone:901-682-4456
Mailing Address - Fax:901-207-4882
Practice Address - Street 1:1364 CORDOVA CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2200
Practice Address - Country:US
Practice Address - Phone:901-682-4456
Practice Address - Fax:901-207-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19135208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4054019OtherAETNA
TN0084911OtherBLUECROSS BLUESHIELD TN
TN4054019OtherAETNA
TN0084911OtherBLUECROSS BLUESHIELD TN