Provider Demographics
NPI:1033146568
Name:ALEXANDER, ALEX M (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:M
Last Name:ALEXANDER
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 1:114 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8793
Mailing Address - Country:US
Mailing Address - Phone:865-482-9911
Mailing Address - Fax:
Practice Address - Street 1:114 DOVER LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8793
Practice Address - Country:US
Practice Address - Phone:865-482-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074675Medicaid
110235415OtherRR MEDICARE
TN3074675Medicaid
110235415OtherRR MEDICARE
TN3717545Medicare ID - Type UnspecifiedLEGACY GROUP