Basic Information
| Provider Information | |||||||||
| NPI: | 1326095035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DABBS | ||||||||
| FirstName: | RANDAL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634706 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452634706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652923000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 W CLINCH AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655411111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD010273 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00384361 | 01 | TN | RAILROAD MEDICARE | OTHER | 2004772000 | 05 | WV | MEDICAID | 3816671 | 05 | TN | MEDICAID | 00123519 | 05 | MS | MEDICAID | 000000293133 | 01 | KY | BLUE CROSS | OTHER | 3112581 | 01 | TN | BLUE CROSS | OTHER | 5M433 | 01 | AR | BLUE CROSS | OTHER | 1383V | 01 | NC | BLUE CROSS | OTHER | 3816673 | 05 | TN | MEDICAID | 5901029 | 05 | NC | MEDICAID |