Provider Demographics
NPI:1528051174
Name:BLOCK, CLEMENT H JR (MD)
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:H
Last Name:BLOCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPK
Mailing Address - Street 2:ST 200, PHYSICIANS PLAZA
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-483-4366
Mailing Address - Fax:865-483-5957
Practice Address - Street 1:988 OAK RIDGE TURNPIKE
Practice Address - Street 2:ST 200, PHYSICIANS PLAZA
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-483-4366
Practice Address - Fax:865-483-5957
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9527207RG0100X
TNMD09527207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3186499Medicaid
3186490Medicare ID - Type Unspecified
TN3186499Medicare PIN
TN3186499Medicaid