Basic Information
| Provider Information | |||||||||
| NPI: | 1790757821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153425900 | ||||||||
| FaxNumber: | 6153427898 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153425900 | ||||||||
| FaxNumber: | 6153427898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD0000022169 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3090269 | 05 | TN | MEDICAID |