Provider Demographics
NPI:1497708739
Name:TARR, JACK H (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:H
Last Name:TARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 52268
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2268
Mailing Address - Country:US
Mailing Address - Phone:865-584-2146
Mailing Address - Fax:865-584-9660
Practice Address - Street 1:1300 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1291
Practice Address - Country:US
Practice Address - Phone:865-584-2146
Practice Address - Fax:865-584-9660
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3176975Medicaid
TN3176975Medicaid
TNB03738Medicare UPIN