Provider Demographics
NPI:1174573653
Name:TOMBUL, SELCUK A (DO)
Entity type:Individual
Prefix:
First Name:SELCUK
Middle Name:A
Last Name:TOMBUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 MCCALLIE AVE
Mailing Address - Street 2:PLAZA III, SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3239
Mailing Address - Country:US
Mailing Address - Phone:423-629-4106
Mailing Address - Fax:423-629-4116
Practice Address - Street 1:2341 MCCALLIE AVE
Practice Address - Street 2:PLAZA III, SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3239
Practice Address - Country:US
Practice Address - Phone:423-629-4106
Practice Address - Fax:423-629-4116
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-054898207R00000X
FLOS054898207RC0000X
TN1907207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA762778785AMedicaid
FL46778OtherBLUE CROSS BLUE SHIELD
TN3300034Medicare PIN
FLG03108Medicare UPIN
GA762778785AMedicaid