Provider Demographics
NPI:1003862566
Name:SOBLE, MARC G (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:G
Last Name:SOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD370172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300137011OtherRAILROAD MEDICARE
TN4049694OtherBCBS
TN4201017OtherBCBS TN
TN4291377OtherBCBS - MTI
TN3879874Medicaid
TN1509316Medicaid
TN4049704OtherBCBS
TN1509316OtherMEDICAID - MTI
KY64059967OtherKY MEDICAID
TN4291377OtherBCBS - MTI
TN4201017OtherBCBS TN
TN3879875Medicare PIN
TNE57345Medicare UPIN
TN1509316Medicaid