Provider Demographics
NPI:1689660375
Name:DLABACH, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:DLABACH
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 1:99 MARKET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6913
Mailing Address - Country:US
Mailing Address - Phone:901-861-9610
Mailing Address - Fax:901-861-9611
Practice Address - Street 1:99 MARKET CENTER DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-6913
Practice Address - Country:US
Practice Address - Phone:901-861-9610
Practice Address - Fax:901-861-9611
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28662207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000323Medicare PIN
TNH01147Medicare UPIN