Provider Demographics
NPI:1770539512
Name:PARDUE, RANDY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:THOMAS
Last Name:PARDUE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:280 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:865-539-0270
Mailing Address - Fax:865-539-6998
Practice Address - Street 1:280 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-539-0270
Practice Address - Fax:865-539-6998
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN20447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3052151Medicaid
TNE57541Medicare UPIN
TN3052151Medicaid