Healthcare Provider Details

I. General information

NPI: 1588664627
Provider Name (Legal Business Name): RAYMOND BRIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DOWELL SPRINGS ROAD SUITE 200
KNOXVILLE TN
37909-1292
US

IV. Provider business mailing address

PO BOX 52167
KNOXVILLE TN
37950-2167
US

V. Phone/Fax

Practice location:
  • Phone: 865-246-1958
  • Fax: 865-246-0955
Mailing address:
  • Phone: 865-246-1958
  • Fax: 865-246-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number34595
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD0000024684
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: