Individual
GERALD L MANCEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 20TH ST STE 404, KNOXVILLE, TN 37916-1822
(865) 522-6964
(833) 908-2088
Mailing address
1275 DICK LONAS RD UNIT 101, KNOXVILLE, TN 37909-1383
(865) 500-2143
(865) 381-1509
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14580
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1100098566
RR MEDICARE PIN
TN
05
—
3198177
—
TN
Enumeration date
06/15/2006
Last updated
10/18/2023
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