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Individual

JEFFREY BLAIR STAACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
341 TRANE DR, KNOXVILLE, TN 37919-6053
(865) 588-0880
Mailing address
5513 DOGWOOD RD, KNOXVILLE, TN 37918-4221
(865) 689-2278

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
44686
TN

Other

Enumeration date
06/14/2007
Last updated
08/25/2009
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