Individual
DR. FREDRIC R MISHKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
135 W RAVINE RD, SUITE 3A, KINGSPORT, TN 37660-3847
(423) 246-6777
(423) 246-7766
Mailing address
135 W RAVINE RD, SUITE 3A, KINGSPORT, TN 37660-3847
(423) 246-6777
(423) 246-7766
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD19796
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000053385
ANTHEM
KY
01
—
000127737
BCBS OF TN
TN
05
—
006025552
—
VA
01
—
057653
ANTHEM
VA
01
—
100010463
PHP TENNCARE
TN
05
—
1803461000
—
WV
05
—
3700033
—
TN
01
—
4675304
AETNA
TN
05
—
64794654
—
KY
01
—
TN0103
UNITED HEALTHCARE RIVER V
TN
Enumeration date
09/12/2005
Last updated
05/23/2008
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