Healthcare Provider Details

I. General information

NPI: 1023338688
Provider Name (Legal Business Name): LAURA M ENOMOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY STE 300
KNOXVILLE TN
37920-1555
US

IV. Provider business mailing address

PO BOX 415000-MSC8159
NASHVILLE TN
37241-8159
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9218
  • Fax: 865-305-8262
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT197293
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number59953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: