Provider Demographics
NPI:1063582278
Name:MROZ, CHRISTINE T (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:T
Last Name:MROZ
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 1:6005 PARK AVE
Mailing Address - Street 2:#700
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5217
Mailing Address - Country:US
Mailing Address - Phone:901-527-3391
Mailing Address - Fax:901-578-3969
Practice Address - Street 1:6005 PARK
Practice Address - Street 2:#700
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5217
Practice Address - Country:US
Practice Address - Phone:901-527-3391
Practice Address - Fax:901-578-3969
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111702086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN316700Medicaid
TN316700Medicare ID - Type Unspecified
TN316700Medicaid