Healthcare Provider Details

I. General information

NPI: 1992853667
Provider Name (Legal Business Name): DAVID W ANGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E OAK HILL AVE RADIATION THERAPY DEPARTMENT
KNOXVILLE TN
37917-4505
US

IV. Provider business mailing address

PO BOX 3877
KNOXVILLE TN
37927-3877
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9554
  • Fax:
Mailing address:
  • Phone: 865-544-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number9152
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: