Provider Demographics
NPI:1245458082
Name:CASILLAS, MARK A JR (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:CASILLAS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1934 ALCOA HIGHWAY
Mailing Address - Street 2:BLDG D, SUITE 370
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-305-5335
Mailing Address - Fax:865-305-8840
Practice Address - Street 1:1934 ALCOA HIGHWAY
Practice Address - Street 2:BLDG D, SUITE 370
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-305-5335
Practice Address - Fax:865-305-8840
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2014-02-04
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Provider Licenses
StateLicense IDTaxonomies
RILP00968208600000X
TN48676208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery