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Individual

BLAINE L. ENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1924 ALCOA HWY, U114, KNOXVILLE, TN 37920-1511
(865) 305-9340
(865) 305-9231
Mailing address
PO BOX 440473, NASHVILLE, TN 37244-0473
(865) 670-6199
(865) 670-6188

Taxonomy

Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
MD0000018190
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3028290
TN
05
3028291
TN
Enumeration date
06/14/2006
Last updated
09/27/2011
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