Provider Demographics
NPI:1710644109
Name:DABNEY, ROBERT LEE JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:DABNEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 MONTCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5076
Mailing Address - Country:US
Mailing Address - Phone:901-338-8577
Mailing Address - Fax:
Practice Address - Street 1:2475 MONTCLAIR LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5076
Practice Address - Country:US
Practice Address - Phone:901-338-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist