Provider Demographics
NPI:1124085634
Name:EBER, PAUL RICHARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:EBER
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 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3411
Mailing Address - Fax:901-384-6422
Practice Address - Street 1:1325 WOLF PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1742
Practice Address - Country:US
Practice Address - Phone:901-252-3400
Practice Address - Fax:901-682-0047
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18433208800000X
TN20950208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3132206OtherCIGNA
TN3889738Medicaid
13002331OtherPHCS
433985OtherHEALTH LINK
4503998OtherAETNA
4075544OtherBLUE CROSS TN
3132206OtherCIGNA
4075544OtherBLUE CROSS TN
4503998OtherAETNA
04030011300OtherQUAL CHOICE
TN3889738Medicare ID - Type Unspecified
433985OtherHEALTH LINK
E96724Medicare UPIN