Provider Demographics
NPI:1497725089
Name:POLLACK, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:POLLACK
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 1:1819 W CLINCH AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2434
Mailing Address - Country:US
Mailing Address - Phone:865-523-6418
Mailing Address - Fax:865-523-6587
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2434
Practice Address - Country:US
Practice Address - Phone:865-523-6418
Practice Address - Fax:865-523-6587
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34023207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3850554Medicare ID - Type Unspecified
TNE93067Medicare UPIN