Healthcare Provider Details

I. General information

NPI: 1245438605
Provider Name (Legal Business Name): MARY ES BEAVER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 E EMERALD AVE SUITE 720
KNOXVILLE TN
37917-4539
US

IV. Provider business mailing address

930 E EMERALD AVE SUITE 720
KNOXVILLE TN
37917-4539
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-3340
  • Fax: 865-522-3511
Mailing address:
  • Phone: 865-522-3340
  • Fax: 865-522-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number39575
License Number StateTN

VIII. Authorized Official

Name: DR. MARY-ES A BEAVER
Title or Position: OWNER
Credential: M.D.
Phone: 865-522-3340