Provider Demographics
NPI:1588858567
Name:YIBIRIN PELUFFO, EDMUNDO H (MD)
Entity Type:Individual
Prefix:MR
First Name:EDMUNDO
Middle Name:H
Last Name:YIBIRIN PELUFFO
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 1:1515 ROCKWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:573-880-0593
Mailing Address - Fax:615-462-7062
Practice Address - Street 1:301 WOLVERINE TRAIL
Practice Address - Street 2:SUITE 202
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-801-2087
Practice Address - Fax:615-462-7062
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000043802207V00000X
MO2015006482207V00000X, 207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029376Medicaid
TNMD0000043802OtherMEDICAL LICENSE