Provider Demographics
NPI:1578961967
Name:AUSTIN, ROBERT SHAUN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SHAUN
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DR
Mailing Address - Street 2:PHYSICIANS PLAZA I, SUITE 209
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1979
Mailing Address - Country:US
Mailing Address - Phone:865-251-3030
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:PHYSICIANS PLAZA I, SUITE 209
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-251-3030
Practice Address - Fax:865-966-0191
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2700363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I970455Medicare PIN