Provider Demographics
NPI:1255376513
Name:JERDEN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JERDEN
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 1:6600 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2754
Mailing Address - Country:US
Mailing Address - Phone:865-632-5885
Mailing Address - Fax:865-374-2163
Practice Address - Street 1:6600 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2754
Practice Address - Country:US
Practice Address - Phone:865-632-5885
Practice Address - Fax:865-374-2163
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3849687Medicaid
H09147Medicare UPIN
TN3849689Medicare ID - Type UnspecifiedLEGACY PIN
TN3849687Medicaid