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NPI Code Detail

MEDICARE: DONALD T. ELLENBURG M.D.

MEDICARE: DONALD T. ELLENBURG M.D.
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
1208000000XPediatrics Physician31722TN
2207K00000XAllergy & Immunology Physician3958TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115689OTHERTNBCBS OF TN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3602002950OTHERTNCARITEN

General Provider Information

NPI Number : 1548354475
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD T. ELLENBURG M.D.
Provider Business Mailing Address
First Line : 2121 HIGHLAND AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37916-1111
Country : US
Telephone Number : 865-525-2640
Fax Number : 865-525-9536
Provider Business Practice Location Address
First Line : 2121 HIGHLAND AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37916-1111
Country : US
Telephone Number : 865-525-2640
Fax Number : 865-525-9536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 02/17/2025

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