Individual
DR. DOUGLAS ADAM JENTILET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 W CLINCH AVE, KNOXVILLE, TN 37916-2307
(865) 541-1111
Mailing address
3200 MACCORKLE AVENUE SE, EMERGENCY DEPARTMENT, CHARLESTON, WV 25304
(304) 388-4172
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25747
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3819457
—
TN
01
—
4122982
BLUE CROSS
TN
01
—
4152067
BLUE CROSS
TN
01
—
P00333205
RAILROAD MEDICARE
TN
Enumeration date
06/09/2006
Last updated
03/01/2017
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