Provider Demographics
NPI:1679671515
Name:BROOME, WILLIAM SMITH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SMITH
Last Name:BROOME
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:PO BOX 440471
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0471
Mailing Address - Country:US
Mailing Address - Phone:865-523-5235
Mailing Address - Fax:865-523-2003
Practice Address - Street 1:4410 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1304
Practice Address - Country:US
Practice Address - Phone:865-523-5235
Practice Address - Fax:865-523-2003
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000013894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B59534Medicare UPIN
TN3196523Medicare ID - Type Unspecified
TN080155869Medicare PIN