Basic Information
| Provider Information | |||||||||
| NPI: | 1073703971 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAUL S. AMBROSE, M.D., P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9349 PARK WEST BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656904731 | ||||||||
| FaxNumber: | 8656937484 | ||||||||
| Practice Location | |||||||||
| Address1: | 9349 PARK WEST BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656904731 | ||||||||
| FaxNumber: | 8656937484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 05/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | AMBROSE, M.D. | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/HEAD DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8656904731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD0000006952 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.