Provider Demographics
NPI:1609934728
Name:KLEIER, ERNEST BOBBY JR (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:BOBBY
Last Name:KLEIER
Suffix:JR
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 1:209 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1510
Mailing Address - Country:US
Mailing Address - Phone:931-296-9830
Mailing Address - Fax:931-296-7350
Practice Address - Street 1:209 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1510
Practice Address - Country:US
Practice Address - Phone:931-296-9830
Practice Address - Fax:931-296-7350
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9046208600000X
MOMDR3L21208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4027561OtherBCBS SURGERY
TN3183707Medicaid
TN4080719OtherBCBS PRIMARY CARE
TN3183707Medicare ID - Type Unspecified
TN3183707Medicaid