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DR. MARK JOSEPH DALLE-AVE M.D.

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1801892054

Individual Registrant:
DR. MARK JOSEPH DALLE-AVE M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4307 HIGHWAY 66 S  ROGERSVILLE, TN 37857-3155 US
Tel: 423-921-1600  Fax: 423-921-1677

Contact information for business:
PO BOX 850  ROGERSVILLE, TN 37857-0850 US
Tel: 423-272-5202  Fax: 423-272-4696

Registration Information:
NPI: 1801892054
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
TN25875

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
3085703TN05
BCBST4057107TN01




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