Provider Demographics
NPI:1255428231
Name:WORKMAN, EDWARD ALVA (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALVA
Last Name:WORKMAN
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 1:110 PERIMETER PARK RD STE C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2200
Mailing Address - Country:US
Mailing Address - Phone:865-862-0763
Mailing Address - Fax:865-862-0764
Practice Address - Street 1:110 PERIMETER PARK RD STE C
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2200
Practice Address - Country:US
Practice Address - Phone:865-862-0763
Practice Address - Fax:865-862-0764
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19179174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND93124Medicare UPIN
TN3837781Medicare ID - Type Unspecified