Healthcare Provider Details

I. General information

NPI: 1245225424
Provider Name (Legal Business Name): DAVID ALLEN MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3330
US

IV. Provider business mailing address

9711 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3330
US

V. Phone/Fax

Practice location:
  • Phone: 865-373-5050
  • Fax:
Mailing address:
  • Phone: 865-373-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD26883
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: