Individual
DIANE ALLEN SHUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5623 OOLTEWAH RINGGOLD RD, OOLTEWAH, TN 37363-7806
(423) 238-5668
(423) 238-5170
Mailing address
5623 OOLTEWAH RINGGOLD RD, PO BOX 731, OOLTEWAH, TN 37363-7806
(423) 238-5668
(423) 238-5170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14062
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036498
BLUE CROSS BLUE SHIELD
TN
01
—
010010624
RAILROAD MEDICARE
TN
05
—
3009848
—
TN
Enumeration date
05/10/2006
Last updated
02/05/2010
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