Provider Demographics
NPI:1659377679
Name:COUCH, DAVID ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLAN
Last Name:COUCH
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 1:320 PROSPERITY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4709
Mailing Address - Country:US
Mailing Address - Phone:423-756-1512
Mailing Address - Fax:
Practice Address - Street 1:2412 N JOHN B DENNIS HWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4772
Practice Address - Country:US
Practice Address - Phone:423-578-4364
Practice Address - Fax:423-578-4372
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35896207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180043086OtherRAILROAD MC VA
TN180043087OtherRAILROAD MEDICARE
TN3715424Medicaid
KY64047194Medicaid
VA006309453Medicaid
VA006310397Medicaid
NC89065YFMedicaid
KY64047194Medicaid
NC2345118Medicare PIN
TNG87047Medicare UPIN
TN3869507Medicare PIN