Provider Demographics
NPI:1992786628
Name:MARK, RUFUS J
Entity type:Individual
Prefix:
First Name:RUFUS
Middle Name:J
Last Name:MARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RUFUS
Other - Middle Name:J
Other - Last Name:MARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 24120
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-2120
Mailing Address - Country:US
Mailing Address - Phone:865-803-4321
Mailing Address - Fax:580-250-5183
Practice Address - Street 1:421 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5048
Practice Address - Country:US
Practice Address - Phone:931-456-8390
Practice Address - Fax:931-456-8389
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ460942085R0001X
TXL24452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ688655Medicaid
TNQ090498Medicaid
TX920006823OtherRAILROAD MEDICARE
NMP00607340OtherRAILROAD MEDICARE
AZ688655Medicaid
NMNM009V38OtherBCBS-NM
TX118562100OtherFIRSTCARE
TX318347YN57Medicare PIN
NM49629565Medicaid
TX8BS070OtherBCBS TX
TX1460982-01Medicaid
TX270798 & 270800Medicare PIN
TX8K8865Medicare PIN