Provider Demographics
NPI:1053340802
Name:TAUER, KURT W (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:TAUER
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 1:7714 POPLAR AVENUE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3941
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6757
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1762
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-922-6757
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12260207RX0202X
ARR3993207RX0202X
TN12823207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4031625OtherAETNA
AR87845OtherAR BCBS
TN3191808Medicaid
AR112757001Medicaid
LA1785652Medicaid
MS00112465Medicaid
TN2002901OtherBCBS TN
MO202995205Medicaid
TN110070709Medicare PIN
TN3191808Medicaid
MS00112465Medicaid
B04485Medicare UPIN