Healthcare Provider Details

I. General information

NPI: 1336115419
Provider Name (Legal Business Name): THOMAS J EBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 BLOUNT AVE
KNOXVILLE TN
37871
US

IV. Provider business mailing address

PO BOX 11784
KNOXVILLE TN
37939-1784
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5992
  • Fax: 865-632-5316
Mailing address:
  • Phone: 865-588-2928
  • Fax: 865-450-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number21500
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: