Provider Demographics
NPI:1912949975
Name:DAILEY, RALPH RUSSELL IV (PA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:RUSSELL
Last Name:DAILEY
Suffix:IV
Gender:M
Credentials:PA
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:7211 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5968
Practice Address - Country:US
Practice Address - Phone:865-584-4747
Practice Address - Fax:865-584-1363
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-03-13
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Provider Licenses
StateLicense IDTaxonomies
TN1209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4093997OtherBLUE CROSS
TN3662928Medicare ID - Type Unspecified
TNPENDINGOtherRRGA
TN3662928Medicaid