Provider Demographics
NPI:1679593024
Name:DEL VALLE, RENE CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:CARLOS
Last Name:DEL VALLE
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:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-0389
Mailing Address - Country:US
Mailing Address - Phone:931-450-5062
Mailing Address - Fax:931-450-5063
Practice Address - Street 1:1615 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3179
Practice Address - Country:US
Practice Address - Phone:931-450-5062
Practice Address - Fax:931-450-5063
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3021346Medicaid
TN01032602OtherAMERIGROUP
TN7440419OtherUNITED HEALTHCARE
TNTN0101OtherAMERICHOICE
TN0059542OtherTENNCARE SELECT
TN0059542OtherBLUECARE
TN0059542OtherBCBS
A98508Medicare UPIN
TN01032602OtherAMERIGROUP