Provider Demographics
NPI:1679648398
Name:MOUNGER, EMERSON JAY (MD MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:JAY
Last Name:MOUNGER
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Gender:M
Credentials:MD MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:SUITE 475 BUILDING C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1523
Mailing Address - Country:US
Mailing Address - Phone:865-305-5000
Mailing Address - Fax:865-305-5001
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE C 475
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1523
Practice Address - Country:US
Practice Address - Phone:865-305-5000
Practice Address - Fax:865-305-5001
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000004719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4024485OtherBCBS
TN3150382Medicaid
TN4024485OtherBCBS
B02302Medicare UPIN