Individual
DR. MARK W. FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 CITICO AVE, CHATTANOOGA, TN 37404-1127
(423) 697-2000
(423) 697-2320
Mailing address
2501 CITICO AVE, CHATTANOOGA, TN 37404-1127
(423) 697-2000
(423) 697-2118
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD44206
TN
2086S0129X
Vascular Surgery Physician
Primary
44206
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515384
—
TN
05
—
163534
—
AL
01
—
4230402
BCBS
TN
05
—
540820812A
—
GA
01
—
P00741318
RR MEDICARE
—
Enumeration date
07/17/2007
Last updated
06/02/2020
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