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Individual

DR. GARY WAYNE LETHCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1924 ALCOA HWY, U67, KNOXVILLE, TN 37920-1511
(865) 305-9350
(865) 305-8681
Mailing address
1924 ALCOA HWY, U67, KNOXVILLE, TN 37920-1511
(865) 305-9350
(865) 305-8681

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000013536
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3373352
MEDICARE GROUP UFP
TN
05
3831165
NE
01
4069424
BLUE CROSS BLUE SHIELD
TN
01
602003960
CARITEN
TN
Enumeration date
11/21/2006
Last updated
11/26/2012
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