Provider Demographics
NPI:1558369736
Name:GUBATAN, VERONICA MANAOIS (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MANAOIS
Last Name:GUBATAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:405 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5823
Practice Address - Country:US
Practice Address - Phone:865-980-5377
Practice Address - Fax:865-980-5376
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD355142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009715Medicaid
TN103I261020Medicare PIN
H58591Medicare UPIN