Provider Demographics
NPI:1225096217
Name:D'OOGE, BENJAMIN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WAYNE
Last Name:D'OOGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 N WINSTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3606
Mailing Address - Country:US
Mailing Address - Phone:800-577-7707
Mailing Address - Fax:865-693-4064
Practice Address - Street 1:188 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762
Practice Address - Country:US
Practice Address - Phone:800-944-7252
Practice Address - Fax:423-784-1136
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0025067207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F89265Medicare UPIN