Provider Demographics
NPI:1629013701
Name:ORTHOEFER, CARL S (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:S
Last Name:ORTHOEFER
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 1:1225 E WEISGARBER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:2240 SUTHERLAND AVE
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2333
Practice Address - Country:US
Practice Address - Phone:865-909-0090
Practice Address - Fax:865-909-9883
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851861Medicaid
TN110205242OtherRR MEDICARE PIN
TN110205242OtherRR MEDICARE PIN
TN3851861Medicaid