Healthcare Provider Details

I. General information

NPI: 1942286935
Provider Name (Legal Business Name): DAVID W DRUM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160A W TENNESSEE AVE
OAK RIDGE TN
37830-6501
US

IV. Provider business mailing address

988 OAK RIDGE TPKE STE L40
OAK RIDGE TN
37830-6940
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-3740
  • Fax: 865-835-3742
Mailing address:
  • Phone: 865-482-4028
  • Fax: 865-835-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0168
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: