Individual
DR. RICHARD GENDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2033 MEADOWVIEW LN, STE 200, KINGSPORT, TN 37660-7569
(423) 857-2260
(423) 857-2261
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101025181
VA
208000000X
Pediatrics Physician
Primary
MD 11397
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006713602
—
VA
05
—
3898501
—
TN
05
—
5440943
—
TN
05
—
6713602
—
VA
Enumeration date
05/24/2005
Last updated
09/16/2009
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