Provider Demographics
NPI:1740287879
Name:SLUTSKY, AVRON ABE (MD)
Entity type:Individual
Prefix:
First Name:AVRON
Middle Name:ABE
Last Name:SLUTSKY
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
Mailing Address - Street 2:DEPT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:6401 POPLAR AVENUE
Practice Address - Street 2:#400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-525-3086
Practice Address - Fax:901-969-1113
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3649784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4008189OtherBLUE CROSS OF TN
TN4031622OtherAETNA
TN3116924Medicaid
TN4008189OtherBLUE CROSS OF TN
TN3116924Medicaid