Individual
DR. RANDALL DEVAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916
(865) 546-8040
(865) 541-2787
Mailing address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
38541
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100045570
PHP TENNCARE
TN
05
—
3892680
—
TN
01
—
4084179
BLUE CROSS
TN
01
—
P00154858
TRAVELERS MEDICARE
TN
Enumeration date
03/09/2006
Last updated
07/10/2018
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