Provider Demographics
NPI:1053998856
Name:BRASHEARS, SAMUEL LUCAS (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LUCAS
Last Name:BRASHEARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:240 MEDICAL PARK BLVD STE 3000
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7352
Mailing Address - Country:US
Mailing Address - Phone:423-990-2400
Mailing Address - Fax:423-990-2417
Practice Address - Street 1:240 MEDICAL PARK BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7352
Practice Address - Country:US
Practice Address - Phone:423-990-2400
Practice Address - Fax:423-990-2417
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN70910207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine