Healthcare Provider Details

I. General information

NPI: 1619947876
Provider Name (Legal Business Name): DANIEL M IBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9957 SHERRILL BLVD
KNOXVILLE TN
37932-3366
US

IV. Provider business mailing address

PO BOX 10988
KNOXVILLE TN
37939-0988
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-2255
  • Fax: 865-691-7888
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number29724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: