Healthcare Provider Details

I. General information

NPI: 1992786628
Provider Name (Legal Business Name): RUFUS J. MARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RUFUS J. MARK M.D.,

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/11/2024
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SOUTH MAIN STREET
CROSSVILLE TN
38555-5048
US

IV. Provider business mailing address

PO BOX 24120
KNOXVILLE TN
37933-2120
US

V. Phone/Fax

Practice location:
  • Phone: 931-456-8390
  • Fax: 931-456-8389
Mailing address:
  • Phone: 865-803-4321
  • Fax: 580-250-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number46094
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: