Healthcare Provider Details

I. General information

NPI: 1346207164
Provider Name (Legal Business Name): ANDREW R. BEJARANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 W EMORY RD
POWELL TN
37849-3704
US

IV. Provider business mailing address

1225 E WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2604
US

V. Phone/Fax

Practice location:
  • Phone: 865-938-5911
  • Fax: 865-938-5924
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: