Provider Demographics
NPI:1083682579
Name:BUZZERD, ADAM PATRICK (PA C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:BUZZERD
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:P
Other - Last Name:BUZZERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1981
Mailing Address - Country:US
Mailing Address - Phone:865-647-3350
Mailing Address - Fax:865-647-3359
Practice Address - Street 1:10810 PARKSIDE DR STE 208
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1981
Practice Address - Country:US
Practice Address - Phone:865-647-3350
Practice Address - Fax:865-647-3359
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103471363AS0400X
TNPA1919363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015212Medicaid
FL2922568 00Medicaid
S96864Medicare UPIN
TN103I979142Medicare PIN
FL2922568 00Medicaid