Provider Demographics
NPI:1336397124
Name:THURMAN, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:THURMAN
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 1:3053 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1720
Mailing Address - Country:US
Mailing Address - Phone:423-968-1144
Mailing Address - Fax:
Practice Address - Street 1:3053 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1720
Practice Address - Country:US
Practice Address - Phone:423-968-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL309302085B0100X, 2085R0202X
TN461692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117788OtherBCBS
AL051117789OtherBCBS
AL051117791OtherBCBS
AL051117792OtherBCBS
AL129538Medicaid
VA1336397124Medicaid
TN1529663Medicaid
TN4322971OtherBCBST
AL051117786OtherBCBS
AL051117793OtherBCBS
AL051117794OtherBCBS
MS09305591Medicaid
AL129510Medicaid
AL129539Medicaid
AL051117787OtherBCBS
AL051117790OtherBCBS
AL129536Medicaid
AL129537Medicaid
AL051118672OtherBCBS
AL129541Medicaid
ALZ17049OtherVIVA
AL129506Medicaid
AL129513Medicaid
AL129518Medicaid
AL129540Medicaid
AL129539Medicaid