Provider Demographics
NPI:1114968328
Name:SEGALL, HERVEY D (MD)
Entity type:Individual
Prefix:DR
First Name:HERVEY
Middle Name:D
Last Name:SEGALL
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 1:850 POPLAR AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA204762085B0100X
TN598132085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A204760OtherBLUE SHIELD
CAP00079643OtherRAIL ROAD MEDICARE
CA00A204760G56OtherCAL OPTIMA
CA00A204760Medicaid
CA00A204760Medicaid
CAWA20476NMedicare PIN
CAP00079643OtherRAIL ROAD MEDICARE
CAWA20476IMedicare PIN
CAWA20476OMedicare PIN
CA00A204760G56OtherCAL OPTIMA
CA00A204760OtherBLUE SHIELD