Provider Demographics
NPI:1457323966
Name:SMITH, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SMITH
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 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4500
Mailing Address - Fax:865-769-4557
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-769-4500
Practice Address - Fax:865-769-4557
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42185207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000091Medicaid
TN4091230OtherCIGNA
TN4156386OtherBLUECROSS BLUESHIELD
TN30000911Medicaid
TNTN01M8OtherUNITED HEALTHCARE
TN7900801OtherAETNA
TN30000911Medicare PIN
TN103I202110Medicare PIN
TN30000912Medicare PIN
TNTN01M8OtherUNITED HEALTHCARE
TN30000913Medicare PIN
TN4156386OtherBLUECROSS BLUESHIELD