Provider Demographics
NPI:1952301459
Name:DEVORE, RUSSELL FOSTER III (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:FOSTER
Last Name:DEVORE
Suffix:III
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 1:9700 TUNBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3426
Mailing Address - Country:US
Mailing Address - Phone:865-599-5543
Mailing Address - Fax:
Practice Address - Street 1:9700 TUNBRIDGE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3426
Practice Address - Country:US
Practice Address - Phone:655-989-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35731207RH0003X
TNMD0000018111207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64008097Medicaid
P00107989OtherRR
TN3045050Medicaid
KY64008097Medicaid
KYP400033937Medicare PIN
TN3045050Medicare PIN