1043507965 NPI number — ANDREW W DAKE MD

Table of content: ANDREW W DAKE MD (NPI 1043507965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043507965 NPI number — ANDREW W DAKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAKE
Provider First Name:
ANDREW
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043507965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 DOWELL SPRINGS BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-637-8812
Provider Business Mailing Address Fax Number:
865-637-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK RIDGE TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE A-402
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-637-8812
Provider Business Practice Location Address Fax Number:
865-824-4886
Provider Enumeration Date:
06/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  54290 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q023591 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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