Provider Demographics
NPI:1740203207
Name:DARBY, DEWAYNE PASCHALL (MD)
Entity Type:Individual
Prefix:
First Name:DEWAYNE
Middle Name:PASCHALL
Last Name:DARBY
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 1:150 W PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4524
Mailing Address - Country:US
Mailing Address - Phone:865-475-6161
Mailing Address - Fax:865-475-9857
Practice Address - Street 1:150 W PRICE RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4524
Practice Address - Country:US
Practice Address - Phone:865-475-6161
Practice Address - Fax:865-475-9857
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
36328OtherBLUE CROSS BLUE SHIELD
TNTN0101OtherJOHN DEERE
TN3712179Medicaid
TN1505858Medicaid
36328OtherBLUE CROSS BLUE SHIELD
TN3005699Medicare ID - Type Unspecified
TN3712179Medicaid