Healthcare Provider Details

I. General information

NPI: 1699940759
Provider Name (Legal Business Name): MATTHEW W. ISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY BOX U109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 51947
KNOXVILLE TN
37950-1947
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax:
Mailing address:
  • Phone: 865-588-0880
  • Fax: 865-584-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number54394
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54394
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: