Provider Demographics
NPI:1326095035
Name:DABBS, RANDAL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:L
Last Name:DABBS
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4706
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-541-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD010273207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00384361OtherRAILROAD MEDICARE
WV2004772000Medicaid
TN3816671Medicaid
MS00123519Medicaid
KY000000293133OtherBLUE CROSS
TN3112581OtherBLUE CROSS
AR5M433OtherBLUE CROSS
NC1383VOtherBLUE CROSS
TN3816673Medicaid
NC5901029Medicaid
KY0954390Medicare PIN
NC2039262AMedicare PIN
KY000000293133OtherBLUE CROSS
TN3112581OtherBLUE CROSS
WV4106163Medicare PIN
AR5M433OtherBLUE CROSS