Provider Demographics
NPI:1689784985
Name:PASSONS, GARY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:PASSONS
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 1:909 RIDGEWAY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-683-1112
Mailing Address - Fax:901-683-1174
Practice Address - Street 1:909 RIDGEWAY LOOP RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4016
Practice Address - Country:US
Practice Address - Phone:901-683-1112
Practice Address - Fax:901-683-1174
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30235061Medicaid
TN3023507Medicaid
TN4176670OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN4176670OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN3023507Medicare PIN
TN30235061Medicare PIN
TNP00472952Medicare PIN
TN3023507Medicaid
TN30235061Medicaid