Provider Demographics
NPI:1851387872
Name:ROBERTSON, JOHN F III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ROBERTSON
Suffix:III
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:PO BOX 52948
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2948
Mailing Address - Country:US
Mailing Address - Phone:865-306-5700
Mailing Address - Fax:865-584-7760
Practice Address - Street 1:2 PROFESSIONAL PARK DR STE 11
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6584
Practice Address - Country:US
Practice Address - Phone:423-975-5650
Practice Address - Fax:423-975-5652
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36238208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016502830002Medicaid
TNQ013108Medicaid
TNQ013108Medicaid
TN103I011096Medicare PIN
TN3873100Medicare PIN
TN3873100Medicaid