Provider Demographics
NPI:1407896582
Name:ROBBINS, JAN G (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:G
Last Name:ROBBINS
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 1:1226 N SHOREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37714-3766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18797 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2127
Practice Address - Country:US
Practice Address - Phone:423-569-8521
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25351207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64919392Medicaid
TN3083124Medicaid
TN3083124Medicare ID - Type Unspecified
TN3083124Medicaid