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General NPI Number Information
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NPI Number | 1952301459
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Entity Type | Individual
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Provider Name | RUSSELL FOSTER DEVORE III MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 9700 TUNBRIDGE LN
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City | KNOXVILLE
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State | TN
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Zip | 37922-3426
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Country | US
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Telephone | 655-989-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 TUNBRIDGE LN
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City | KNOXVILLE
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State | TN
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Zip | 37922-3426
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Country | US
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Telephone | 865-599-5543
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Fax |
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 35731
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD0000018111
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License Number State | TN
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