Provider Demographics
NPI:1659312239
Name:MCCOLL, MARK BENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENTON
Last Name:MCCOLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:865-539-0270
Mailing Address - Fax:865-539-6998
Practice Address - Street 1:280 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-539-0270
Practice Address - Fax:865-539-6998
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000040833207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000040833OtherMEDICAL LICENSE
TNMD0000040833OtherMEDICAL LICENSE