Provider Demographics
NPI:1962578005
Name:BRECKENRIDGE, RUFUS G (MD)
Entity type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:G
Last Name:BRECKENRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:
Practice Address - Street 1:109 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5603
Practice Address - Country:US
Practice Address - Phone:423-638-4131
Practice Address - Fax:423-638-9239
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000039Medicaid
TN2008551OtherBLUE CROSS BLUE SHIELD TN
TN2008551OtherBLUE CARE TN
TN2008551OtherBLUE CARE TN
TND29029Medicare UPIN