Provider Demographics
NPI:1467449041
Name:DAVIS, TYRONE TEAKO (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:TEAKO
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MADISON AVE
Mailing Address - Street 2:2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2226
Mailing Address - Country:US
Mailing Address - Phone:901-523-7698
Mailing Address - Fax:901-272-2045
Practice Address - Street 1:1204 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2226
Practice Address - Country:US
Practice Address - Phone:901-523-7698
Practice Address - Fax:901-272-2045
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN652213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64500Medicare UPIN