Healthcare Provider Details

I. General information

NPI: 1821092453
Provider Name (Legal Business Name): STEPHEN M. TREON MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN MARSHAL TREON MD, PHD

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 OCOEE ST
COPPERHILL TN
37317
US

IV. Provider business mailing address

PO BOX 1107 141 OCOEE
COPPERHILL TN
37317-1107
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-4103
  • Fax: 423-496-4106
Mailing address:
  • Phone: 423-496-4103
  • Fax: 423-496-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD0000024711
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000024711
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: