Provider Demographics
NPI:1942286935
Name:DRUM, DAVID W (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:DRUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE STE L40
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6940
Mailing Address - Country:US
Mailing Address - Phone:865-482-4028
Mailing Address - Fax:865-835-3742
Practice Address - Street 1:160A W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6501
Practice Address - Country:US
Practice Address - Phone:865-835-3740
Practice Address - Fax:865-835-3742
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0168363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508048Medicaid
TNR60744Medicare UPIN
TN1508048Medicaid
3376148Medicare PIN