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General NPI Number Information
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NPI Number | 1720118086
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Entity Type | Organization
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Legal Business Name | OAK RIDGE UROLOGY ASSOCIATES
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 OAK RIDGE TPKE SUITE A 101
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-483-1093
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Fax | 865-482-8629
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Provider Business Mailing Address
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Address Line | 800 OAK RIDGE TPKE SUITE A 101
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-483-1093
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Fax | 865-482-8629
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TONYA DEGUIRA
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Credential |
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Telephone | 865-483-1093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | MD 29931
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License Number State | TN
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