Provider Demographics
NPI:1508868969
Name:MIRE, ANWAR DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:DEAN
Last Name:MIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 BLOUNT AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1606
Mailing Address - Country:US
Mailing Address - Phone:865-549-4444
Mailing Address - Fax:865-549-4449
Practice Address - Street 1:200 BLOUNT AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1606
Practice Address - Country:US
Practice Address - Phone:865-549-4444
Practice Address - Fax:865-549-4449
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD16224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3020243Medicaid
TN3020243Medicaid
A98393Medicare UPIN
TN103I082393Medicare PIN