Provider Demographics
NPI:1861495152
Name:POMPHREY, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:POMPHREY
Suffix:
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 1:1014 BELL STORE RD
Mailing Address - Street 2:
Mailing Address - City:GLEASON
Mailing Address - State:TN
Mailing Address - Zip Code:38229-6418
Mailing Address - Country:US
Mailing Address - Phone:731-571-8960
Mailing Address - Fax:
Practice Address - Street 1:16615 HIGHWAY 104 N STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-5753
Practice Address - Country:US
Practice Address - Phone:731-968-0660
Practice Address - Fax:731-968-0007
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29910207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD29910OtherMEDICAL LICENSE
TNQ055139Medicaid
TN3380640OtherMEDICAID GROUP
TN3833270Medicaid
TNBP5707786OtherDEA LICENSE
TN3380640OtherMEDICAID GROUP