Basic Information
| Provider Information | |||||||||
| NPI: | 1053371674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSSEN | ||||||||
| FirstName: | HERMANN | ||||||||
| MiddleName: | PETER VALENTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11105 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379391105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655882928 | ||||||||
| FaxNumber: | 8654509374 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 OAK RIDGE TPKE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654811162 | ||||||||
| FaxNumber: | 8654811863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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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 | 2085R0202X | 29823 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4057801 | 01 | TN | BC/BS OF TN | OTHER | 64062391 | 05 | KY | MEDICAID | 3852824 | 05 | TN | MEDICAID |