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Individual

DAVID KENNETH FENNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500
Mailing address
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500

Taxonomy

Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
MD0000008020
TN
207R00000X
Internal Medicine Physician
Primary
8020
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110147422
RAILROAD MEDICARE
TN
01
202731
BLUECROSS BLUESHIELD
TN
01
P01302537
RR MEDICARE
TN
05
Q002461
TN
01
TN0108
AMERICHOICE
TN
Enumeration date
09/28/2006
Last updated
12/17/2014
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