| Knoxville Center For Dermatology And Plastic Surgery, Pl | |
|
9430 Park West Blvd Ste 240 Knoxville TN 37923 | |
| (865) 470-4127 | |
| (833) 790-3693 |
| Full Name | Knoxville Center For Dermatology And Plastic Surgery, Pl |
|---|---|
| Speciality | Clinic/Center |
| Location | 9430 Park West Blvd Ste 240, Knoxville, Tennessee |
| Authorized Official Name and Position | Daniel P. Fowler (OWNER) |
| Authorized Official Contact | 8654704124 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Knoxville Center For Dermatology And Plastic Surgery, Pl Po Box 11268 Knoxville TN 37939-1268 Ph: (865) 470-4127 | Knoxville Center For Dermatology And Plastic Surgery, Pl 9430 Park West Blvd Ste 240 Knoxville TN 37923 Ph: (865) 470-4127 |
| NPI Number | 1942703848 |
|---|---|
| Provider Enumeration Date | 03/16/2018 |
| Last Update Date | 06/05/2018 |
| Medicare PECOS PAC ID | 9436406717 |
|---|---|
| Medicare Enrollment ID | O20180717004224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942703848 | NPI | - | NPPES |
| Q035060 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Tennessee) | Primary |
| Provider Name | Daniel P Fowler |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1154582450 PECOS PAC ID: 4981838562 Enrollment ID: I20141006001156 |
| Provider Name | Carley O'shea Fowler |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1619204476 PECOS PAC ID: 3678701257 Enrollment ID: I20150128000423 |
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