Healthcare Provider Details

I. General information

NPI: 1063595775
Provider Name (Legal Business Name): ROSS S KENDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 PAPERMILL DR STE 202
KNOXVILLE TN
37909
US

IV. Provider business mailing address

4709 PAPERMILL DR STE 202
KNOXVILLE TN
37909
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-2881
  • Fax: 865-558-1649
Mailing address:
  • Phone: 865-522-2881
  • Fax: 865-558-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: