Provider Demographics
NPI:1245242221
Name:SOUDER, MARVA L (MD)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:L
Last Name:SOUDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-345-4640
Mailing Address - Fax:901-399-7973
Practice Address - Street 1:2900 KIRBY RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-345-4640
Practice Address - Fax:901-399-7973
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19036207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047477Medicaid
TN3047477Medicaid
TN3047478Medicare PIN