Healthcare Provider Details

I. General information

NPI: 1730569716
Provider Name (Legal Business Name): MEGAN PAZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 HIGHWAY 411
VONORE TN
37885-2455
US

IV. Provider business mailing address

PO BOX 278
MADISONVILLE TN
37354-0278
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-3277
  • Fax: 423-884-7271
Mailing address:
  • Phone: 423-442-2622
  • Fax: 423-442-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT016730
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: