Healthcare Provider Details

I. General information

NPI: 1912281221
Provider Name (Legal Business Name): MICHAEL C DOODY, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FORT SANDERS WEST BLVD SUITE 106
KNOXVILLE TN
37922-3398
US

IV. Provider business mailing address

220 FORT SANDERS WEST BLVD SUITE 106
KNOXVILLE TN
37922-3398
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-3011
  • Fax: 865-531-7582
Mailing address:
  • Phone: 865-531-3011
  • Fax: 865-531-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD18002
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL C DOODY
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 865-531-3011