Healthcare Provider Details

I. General information

NPI: 1548586035
Provider Name (Legal Business Name): OAK RIDGE RADIATION ONCOLOGY P LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 VERMONT AVE
OAK RIDGE TN
37830-6402
US

IV. Provider business mailing address

PO BOX 129
FLAGLER BEACH FL
32136-0129
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-4500
  • Fax: 865-835-4503
Mailing address:
  • Phone: 865-835-4500
  • Fax: 865-835-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD0000025245
License Number StateTN

VIII. Authorized Official

Name: DR. ELLIOT BRIN NAVO
Title or Position: AO
Credential: MD
Phone: 865-835-4500