Provider Demographics
NPI:1124209879
Name:GARY A SPIEGELMAN MD
Entity type:Organization
Organization Name:GARY A SPIEGELMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SPIEGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-531-8632
Mailing Address - Street 1:PO BOX 30529
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-0529
Mailing Address - Country:US
Mailing Address - Phone:865-531-8632
Mailing Address - Fax:865-531-9874
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-531-8632
Practice Address - Fax:865-531-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD023743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376175Medicare PIN