Provider Demographics
NPI:1134105919
Name:PRIMKA, EDWARD JOHN III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:PRIMKA
Suffix:III
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 1:1450 DOWELL SPRINGS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2448
Mailing Address - Country:US
Mailing Address - Phone:865-524-2547
Mailing Address - Fax:865-205-5601
Practice Address - Street 1:1450 DOWELL SPRINGS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2448
Practice Address - Country:US
Practice Address - Phone:865-524-2547
Practice Address - Fax:865-205-5601
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035486207NS0135X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN386126Medicaid
TN100035981OtherPHP TNCARE
TN5533476OtherAETNA
SD70015833OtherRAILROAD MEDICARE
SD621247710OtherTRICARE FARRAGUT
TN340133OtherUNITED HEALTHCARE
TN3788990004OtherCIGNA
TN4015496OtherBLUE CROSS BLUE SHIELD
TN621247710001OtherTRICARE ST.MARY'S