Provider Demographics
NPI:1881858215
Name:ROBERTSON, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:170 BEECH ST STE 1
Mailing Address - Street 2:P.O. BOX 750
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8251
Mailing Address - Country:US
Mailing Address - Phone:423-869-3684
Mailing Address - Fax:423-869-5460
Practice Address - Street 1:170 BEECH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8251
Practice Address - Country:US
Practice Address - Phone:423-869-3684
Practice Address - Fax:423-869-5460
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2016-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN53166207Q00000X
TN47585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN47585OtherLICENSE
TN47585OtherLICENSE