MEDICARE: EARL EDWARD BREAZEALE, JR., MD, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1912992272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARL EDWARD BREAZEALE, JR., MD, PC

Provider Business Mailing Address
First Line	:	2068 LAKESIDE CENTRE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922
Country	:	US
Telephone Number	:	865-342-0300
Fax Number	:	865-342-0300

Provider Business Practice Location Address
First Line	:	2068 LAKESIDE CENTRE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6591
Country	:	US
Telephone Number	:	865-342-0300
Fax Number	:	865-342-0301

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSAN BREAZEALE
Credential	:
Telephone Number	:	865-342-0300

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/03/2010

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