Healthcare Provider Details

I. General information

NPI: 1407862238
Provider Name (Legal Business Name): MARIA F RUEDA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11546 CHAPMAN HWY
SEYMOUR TN
37865-5044
US

IV. Provider business mailing address

6700 BAUM DR SUITE ONE
KNOXVILLE TN
37919-7344
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-5252
  • Fax: 865-286-1169
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD38619
License Number StateTN

VIII. Authorized Official

Name: MRS. REBECCA A CONNER
Title or Position: AR ADMINISTRATOR
Credential:
Phone: 865-584-5727