Provider Demographics
NPI:1629022066
Name:OSWELL, YVETTE RANDLE (MD)
Entity type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:RANDLE
Last Name:OSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 STAGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3164
Mailing Address - Country:US
Mailing Address - Phone:901-382-2040
Mailing Address - Fax:901-386-5242
Practice Address - Street 1:5142 STAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3164
Practice Address - Country:US
Practice Address - Phone:901-382-2040
Practice Address - Fax:901-386-5242
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028644173000000X
TN28644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58091Medicare UPIN
TN10308I4208Medicare PIN