Provider Demographics
NPI:1730156076
Name:MATHIEN, GREGORY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:MATHIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1293
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:865-558-4471
Practice Address - Street 1:1422 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1293
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4471
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21414207XX0005X
TNMD21414207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0120OtherJOHN DEERE HEALTHCARE
TN100010064OtherTENNCARE
TN1196196OtherUNITED HEALTH CARE
TNTN0152OtherJOHN DEERE HEALTHCARE
TN3059706Medicaid
TN4397728OtherAETNA
TN200030088OtherRAILROAD MEDICARE
TN3071385OtherBLUE CROSS BLUE SHIELD
TN098041241OtherTRICARE
TNP00910368OtherRAILROAD MEDICARE
TN3059706Medicaid
E83026Medicare UPIN
3059709Medicare ID - Type Unspecified
TNP00910368OtherRAILROAD MEDICARE