Healthcare Provider Details

I. General information

NPI: 1265433783
Provider Name (Legal Business Name): DANIEL R BUSTAMANTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY BOX U109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

319 ERIN DR SUITE B
KNOXVILLE TN
37919-6202
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9220
  • Fax:
Mailing address:
  • Phone: 865-588-0880
  • Fax: 865-584-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number17999
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number17999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: