Provider Demographics
NPI:1700059516
Name:PETER G. STIMPSON MD FAAFP PC
Entity Type:Organization
Organization Name:PETER G. STIMPSON MD FAAFP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:STIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-458-4647
Mailing Address - Street 1:901 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1601
Mailing Address - Country:US
Mailing Address - Phone:865-458-4647
Mailing Address - Fax:865-458-9412
Practice Address - Street 1:901 GROVE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1601
Practice Address - Country:US
Practice Address - Phone:865-458-4647
Practice Address - Fax:865-458-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4971207K00000X, 207R00000X
TN8483207Q00000X
TN27033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094813Medicaid
TN3101689Medicaid
TN3157385Medicaid
B00378Medicare UPIN
3157385Medicare PIN
TN3094813Medicaid
3101689Medicare PIN
TN3101689Medicaid
3094813Medicare PIN