Healthcare Provider Details

I. General information

NPI: 1427373760
Provider Name (Legal Business Name): JONATHAN JAMES KOERTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 634706
CINCINNATI OH
45263-4706
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9000
  • Fax:
Mailing address:
  • Phone: 865-539-8000
  • Fax: 865-560-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD50059
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: