Provider Demographics
NPI:1891806659
Name:USDAN, DAVID AARON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AARON
Last Name:USDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 830B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-682-1752
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 830-B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-685-1886
Practice Address - Fax:901-683-7742
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD5561207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005826OtherBLUE CROSS
182101489OtherRAILROAD MEDICARE
TN2005826OtherBLUE CROSS
182101489OtherRAILROAD MEDICARE