Provider Demographics
NPI:1134171713
Name:FINK, GREGORY W (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:FINK
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:PO BOX 1000 DEPT 960
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-761-2470
Mailing Address - Fax:901-767-4898
Practice Address - Street 1:7655 POPLAR AVE STE 350
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-4933
Practice Address - Country:US
Practice Address - Phone:901-761-2470
Practice Address - Fax:901-767-4898
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53603208G00000X
MS24161208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018208Medicaid
TN6054934OtherBCBS
MS01554513Medicaid
AR212251001Medicaid
AR212251001Medicaid
MS01554513Medicaid