Provider Demographics
NPI:1811994981
Name:HOVIOUS, JOHN RICHARD III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:HOVIOUS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:109 MEADOW VIEW ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1661
Mailing Address - Country:US
Mailing Address - Phone:423-652-1655
Mailing Address - Fax:423-652-7668
Practice Address - Street 1:109 MEADOW VIEW ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1661
Practice Address - Country:US
Practice Address - Phone:423-652-1655
Practice Address - Fax:423-652-7668
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN0000013744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000013744OtherMEDICAL LICENSE NUMBER
VA006725198Medicaid
VA096148OtherANTHEM
TN3045396Medicaid
TN44D0672628OtherCLIA NUMBER
TN71056376201OtherJOHN DEERE
TN110289OtherBLUECROSS/BLUESHIELD TENN
TN4531227OtherAETNA
TNBH1671040OtherDEA NUMBER
TN71056376201OtherJOHN DEERE
TN3045396Medicare ID - Type UnspecifiedMEDICARE
TNBH1671040OtherDEA NUMBER