Healthcare Provider Details

I. General information

NPI: 1225096217
Provider Name (Legal Business Name): BENJAMIN WAYNE D'OOGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL LANE
JELLICO TN
37762
US

IV. Provider business mailing address

1900 N WINSTON RD SUITE 300
KNOXVILLE TN
37919-3606
US

V. Phone/Fax

Practice location:
  • Phone: 800-944-7252
  • Fax: 423-784-1136
Mailing address:
  • Phone: 800-577-7707
  • Fax: 865-693-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0025067
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: