Individual
DR. MARK JOSEPH DALLE-AVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4307 HIGHWAY 66 S, ROGERSVILLE, TN 37857-3155
(423) 921-1600
(423) 921-1677
Mailing address
PO BOX 850, ROGERSVILLE, TN 37857-0850
(423) 272-5202
(423) 272-4696
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25875
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3085703
—
TN
01
—
4057107
BCBST
TN
Enumeration date
06/22/2005
Last updated
02/28/2014
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