Healthcare Provider Details

I. General information

NPI: 1245324938
Provider Name (Legal Business Name): THOMAS BENTON REPINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEW YORK AVE
OAK RIDGE TN
37830-5212
US

IV. Provider business mailing address

1915 WHITE AVE
KNOXVILLE TN
37916-2300
US

V. Phone/Fax

Practice location:
  • Phone: 913-433-7622
  • Fax: 913-433-7623
Mailing address:
  • Phone: 865-541-1485
  • Fax: 865-541-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number46895
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: