Provider Demographics
NPI:1255333977
Name:SCARIANO, JACK EMILE JR (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EMILE
Last Name:SCARIANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:139 FOX RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3472
Mailing Address - Country:US
Mailing Address - Phone:865-769-9595
Mailing Address - Fax:865-769-9510
Practice Address - Street 1:139 FOX RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3472
Practice Address - Country:US
Practice Address - Phone:865-769-9595
Practice Address - Fax:865-769-9510
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006643OtherBLUE CROSS
TN3169834Medicaid
TN2006643OtherBLUE CROSS
TN3169834Medicaid