Provider Demographics
NPI:1073703971
Name:PAUL S. AMBROSE, M.D., P.A.
Entity Type:Organization
Organization Name:PAUL S. AMBROSE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMBROSE, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-690-4731
Mailing Address - Street 1:9349 PARK WEST BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4306
Mailing Address - Country:US
Mailing Address - Phone:865-690-4731
Mailing Address - Fax:865-693-7484
Practice Address - Street 1:9349 PARK WEST BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4306
Practice Address - Country:US
Practice Address - Phone:865-690-4731
Practice Address - Fax:865-693-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000006952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty