Provider Demographics
NPI:1881773778
Name:CLYMER, MARK ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:CLYMER
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 1:1800 MALLORY LN
Mailing Address - Street 2:STE A3
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-661-4005
Mailing Address - Fax:615-661-4015
Practice Address - Street 1:1800 MALLORY LN
Practice Address - Street 2:STE A3
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-661-4005
Practice Address - Fax:615-661-4005
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024947207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD24947OtherMEDICAL
TNBC3795486OtherDEA
F70161Medicare UPIN
TNMD24947OtherMEDICAL