Healthcare Provider Details

I. General information

NPI: 1003294992
Provider Name (Legal Business Name): SPENCER PUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY DEPARTMENT OF MEDICINE U-114 GSM, UTMCK
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY DEPARTMENT OF MEDICINE U-114 GSM, UTMCK
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9340
  • Fax: 865-305-9144
Mailing address:
  • Phone: 865-305-9340
  • Fax: 865-305-9144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58735
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number58735
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: