Basic Information
| Provider Information | |||||||||
| NPI: | 1982650727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLSOP | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | NEAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 FORT SANDERS WEST BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655390270 | ||||||||
| FaxNumber: | 8655609209 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 FORT SANDERS WEST BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655390270 | ||||||||
| FaxNumber: | 8655609209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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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 | 207Q00000X | 20818 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3053371 | 05 | TN | MEDICAID |