MEDICARE: DR. STEPHEN D PERSHING M.D. LLC

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	207R00000X	Internal Medicine Physician	MD0000010526	TN

General Provider Information

NPI Number	:	1114913969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN D PERSHING M.D. LLC

Provider Business Mailing Address
First Line	:	1559 HIGHLAND PARK DR
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6237
Country	:	US
Telephone Number	:	865-635-8382
Fax Number	:	865-635-8388

Provider Business Practice Location Address
First Line	:	1559 HIGHLAND PARK DR
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6237
Country	:	US
Telephone Number	:	865-635-8382
Fax Number	:	423-635-8388

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	05/08/2017

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