Provider Demographics
NPI:1255318762
Name:CRIST, JEFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:CRIST
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 1:9330 PARK WEST BLVD
Mailing Address - Street 2:STE 506
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-539-5372
Mailing Address - Fax:865-539-5369
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:STE 506
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-539-5372
Practice Address - Fax:865-539-5369
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD000021220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022510Medicaid
TN3057737Medicaid
TN3057737Medicaid