Provider Demographics
NPI:1912033606
Name:DAN SMUGOR DPM
Entity Type:Organization
Organization Name:DAN SMUGOR DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMUGOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-925-0324
Mailing Address - Street 1:4608 GILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3150
Mailing Address - Country:US
Mailing Address - Phone:865-925-0324
Mailing Address - Fax:
Practice Address - Street 1:4608 GILLCREST DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-3150
Practice Address - Country:US
Practice Address - Phone:865-925-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352209Medicare ID - Type Unspecified