Provider Demographics
NPI: | 1851585517 |
---|---|
Name: | SILMON, ROBERT W JR (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROBERT |
Middle Name: | W |
Last Name: | SILMON |
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: | 2204 PAVILION DR |
Mailing Address - Street 2: | SUITE 310 |
Mailing Address - City: | KINGSPORT |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37660-4657 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-224-3900 |
Mailing Address - Fax: | 423-224-3901 |
Practice Address - Street 1: | 2204 PAVILION DR |
Practice Address - Street 2: | SUITE 310 |
Practice Address - City: | KINGSPORT |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37660-4657 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-224-3900 |
Practice Address - Fax: | 423-224-3901 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-09-05 |
Last Update Date: | 2011-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
TN | 46757 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4290096 | Other | BCBS |
TN | 1522872 | Medicaid | |
TN | 4290096 | Other | BCBS |