Provider Demographics
NPI:1427098508
Name:FLEENOR, JOHN D (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:FLEENOR
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 1:9245 POPLAR AVE
Mailing Address - Street 2:SUITE 8 #121
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:#1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31953207R00000X, 207P00000X
SC019455207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154560001Medicaid
TN3325050Medicaid
TNH32923Medicare UPIN
AR154560001Medicaid
TN3325052Medicare PIN