Healthcare Provider Details

I. General information

NPI: 1356431472
Provider Name (Legal Business Name): WILLIAM ROBERT MIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 ANDY HOLT
KNOXVILLE TN
37996-0001
US

IV. Provider business mailing address

3624 ISKAGNA DR
KNOXVILLE TN
37919-7762
US

V. Phone/Fax

Practice location:
  • Phone: 865-974-3135
  • Fax: 865-974-2000
Mailing address:
  • Phone: 865-637-8079
  • Fax: 865-974-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15520
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: