Provider Demographics
NPI:1326201567
Name:DESOUZA, ROWENA A (MD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:A
Last Name:DESOUZA
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:PO BOX 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7770
Mailing Address - Fax:901-266-6417
Practice Address - Street 1:57 GERMANTOWN CT
Practice Address - Street 2:SUITE 204
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7273
Practice Address - Country:US
Practice Address - Phone:901-758-7770
Practice Address - Fax:901-266-6417
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202053208800000X
TN51681208800000X, 2088F0040X
TXP0719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009152Medicaid
MS05856545Medicaid
TN6026501OtherBCBS
AR206032001Medicaid
TNP01453290OtherRAILROAD MEDICARE
TN103I340772Medicare PIN