Healthcare Provider Details

I. General information

NPI: 1043209844
Provider Name (Legal Business Name): LEE ROBERT DILWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 W CLINCH AVE SUITE 108
KNOXVILLE TN
37916-2434
US

IV. Provider business mailing address

1819 W CLINCH AVE SUITE 108
KNOXVILLE TN
37916-2434
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-5111
  • Fax: 865-541-4018
Mailing address:
  • Phone: 865-546-5111
  • Fax: 865-541-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD0000016893
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD0000016893
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: