Provider Demographics
NPI:1326363086
Name:FINGERHUT, DAVID ELLIOT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ELLIOT
Last Name:FINGERHUT
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 1:825 RIDGE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9411
Mailing Address - Country:US
Mailing Address - Phone:901-685-2200
Mailing Address - Fax:901-255-5631
Practice Address - Street 1:825 RIDGE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9411
Practice Address - Country:US
Practice Address - Phone:901-685-2200
Practice Address - Fax:901-255-5631
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51161207W00000X, 390200000X, 207W00000X
MS23235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204151001Medicaid
TNQ006295Medicaid
MS08836057Medicaid
TNQ006295Medicaid
NCNCT043AMedicare PIN
MS08836057Medicaid
TN103I186902Medicare PIN