Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Patchouco Theodore, MD

Individual provider Emergency Medicine Physician · NPI 1528628963

Patchouco Theodore, MD is a Family Practice in Knoxville, Tennessee. Qualified in 2018, 8 years ago. Practices as a sole proprietor. Licensed in Louisiana and Tennessee.

Years since qualifying
8
Licensed in
LA, TN
In the registry since
2019
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1924 Alcoa Hwy # U-67
Knoxville, TN 37920-1511
Phone: (865) 305-9350
Fax: (865) 305-8942
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 350083 (LA)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 66626 (TN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1528628963
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 18, 2019
Last updated in NPPESDecember 10, 2025
Certification dateDecember 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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