Provider Demographics
NPI:1891729927
Name:STETSON, ROBERT A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:STETSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALLAN
Other - Last Name:STETSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2650 EXECUTIVE PARK DRIVE NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-473-2633
Mailing Address - Fax:423-473-2643
Practice Address - Street 1:2650 EXECUTIVE PARK DRIVE NW
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-473-2633
Practice Address - Fax:423-473-2643
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME771962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35671Medicare ID - Type Unspecified
H20094Medicare UPIN