Basic Information
Provider Information
NPI: 1003294992
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PUGH
FirstName: SPENCER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1924 ALCOA HWY
Address2: DEPARTMENT OF MEDICINE U-114 GSM, UTMCK
City: KNOXVILLE
State: TN
PostalCode: 379201511
CountryCode: US
TelephoneNumber: 8653059340
FaxNumber: 8653059144
Practice Location
Address1: 1924 ALCOA HWY
Address2: DEPARTMENT OF MEDICINE U-114 GSM, UTMCK
City: KNOXVILLE
State: TN
PostalCode: 379201511
CountryCode: US
TelephoneNumber: 8653059340
FaxNumber: 8653059144
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 12/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/26/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X58735TNY Allopathic & Osteopathic PhysiciansInternal Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home