Provider Demographics
NPI:1619296068
Name:VIETH, ROGER GORDON (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:GORDON
Last Name:VIETH
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 1:1346 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-673-5000
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:1346 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-673-5000
Practice Address - Fax:865-330-6323
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD5529207T00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine