Provider Demographics
NPI:1154429033
Name:VASTINE, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:VASTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:744 MIDDLE CREEK RD 108
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5036
Mailing Address - Country:US
Mailing Address - Phone:865-446-9500
Mailing Address - Fax:865-446-9501
Practice Address - Street 1:744 MIDDLE CREEK RD 108
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5036
Practice Address - Country:US
Practice Address - Phone:865-446-9500
Practice Address - Fax:865-446-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32760Medicare UPIN