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General NPI Number Information
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NPI Number | 1477619872
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Entity Type | Individual
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Provider Name | MARK BRUMMEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 102 E RAVINE RD
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City | KINGSPORT
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State | TN
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Zip | 37660-3814
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Country | US
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Telephone | 423-245-9600
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Fax | 423-245-9634
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-0699
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Country | US
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Telephone | 423-433-6039
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Fax | 423-433-6060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1970
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License Number State | TN
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