Provider Demographics
NPI:1235135856
Name:URI, BOBBIE GWEN (MD)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:GWEN
Last Name:URI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E WEISGARBER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2647
Mailing Address - Country:US
Mailing Address - Phone:865-558-9862
Mailing Address - Fax:865-584-3478
Practice Address - Street 1:1112 E WEISGARBER RD
Practice Address - Street 2:STE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2647
Practice Address - Country:US
Practice Address - Phone:865-558-9862
Practice Address - Fax:865-584-3478
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN180922085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3043858Medicaid
TN3043859Medicaid
TN3043859Medicaid
TN3043859Medicare PIN
TN3043858Medicare PIN