Provider Demographics
NPI:1326228602
Name:ROBERT STETSON, MD, PLLC
Entity Type:Organization
Organization Name:ROBERT STETSON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-473-2633
Mailing Address - Street 1:2650 EXECUTIVE PARK NW
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2746
Mailing Address - Country:US
Mailing Address - Phone:423-473-2633
Mailing Address - Fax:423-473-2643
Practice Address - Street 1:2650 EXECUTIVE PARK NW
Practice Address - Street 2:SUITE #3
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2746
Practice Address - Country:US
Practice Address - Phone:423-473-2633
Practice Address - Fax:423-473-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2084P0800X
TN42758261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30009871Medicare PIN