Gaddis, Roger Dale

Gaddis, Roger Dale is an individual health care provider with primary practice located at 266 Joule St , Alcoa TN 37701-2422. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gaddis, Roger Dale can be contacted via phone (865) 984-3864.

Contact Information

Primary practice address
266 Joule St Alcoa TN 37701-2422
Fax: (865) 380-4095
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X DO0000001730 Tennessee

Profile Details

NPI number 1902009699
LBN Legal business name Gaddis, Roger Dale
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2007
Last updated Jan 13th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902009699 NPPES
Tennessee MEDICAID 4334952
Tennessee MEDICAID 1513698

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