Healthcare Provider Details

I. General information

NPI: 1619296068
Provider Name (Legal Business Name): ROGER GORDON VIETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

IV. Provider business mailing address

1346 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 865-673-5000
  • Fax: 865-330-6323
Mailing address:
  • Phone: 865-673-5000
  • Fax: 865-330-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD5529
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD5529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: