Basic Information
Provider Information
NPI: 1497377873
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARQUAND
FirstName: TREVOR
MiddleName: HELMS
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: UNIVERSITY OF TENNESSEE 920 MADISON AVENUE STE 447
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381630001
CountryCode: US
TelephoneNumber: 9014485814
FaxNumber:  
Practice Location
Address1: UNIVERSITY OF TENNESSEE 920 MADISON AVENUE STE 447
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381630001
CountryCode: US
TelephoneNumber: 9014485814
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2020
LastUpdateDate: 05/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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