Provider Demographics
NPI:1215922547
Name:CUEVAS, CLARISA E (MD)
Entity type:Individual
Prefix:DR
First Name:CLARISA
Middle Name:E
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901
Mailing Address - Country:US
Mailing Address - Phone:865-522-9730
Mailing Address - Fax:865-637-2520
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-546-3998
Practice Address - Fax:865-546-1123
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3497533Medicaid
TN4058480OtherBCBS
TN021313OtherTN MEDICAL LICENSE