MEDICARE: BARRY VICTOR MAVES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD17022	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063487866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY VICTOR MAVES MD

Provider Business Mailing Address
First Line	:	PO BOX 59002
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37950-9002
Country	:	US
Telephone Number	:	865-588-5121
Fax Number	:	865-588-2126

Provider Business Practice Location Address
First Line	:	1311 DOWELL SPRINGS BLVD
Second Line	:	SUITE 300
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2454
Country	:	US
Telephone Number	:	865-588-5121
Fax Number	:	865-588-2126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/04/2017

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