Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 7073 | TN |
Y | 213EG0000X | General Practice | 7073 | TN |
NPI | 1003936436 |
---|---|
Provider Name | Dale Brandon Pittenger |
First Address | Knoxville, TN 37931-3428 |
Second Address | Knoxville, TN 37931-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 03/08/2015 |