Provider Demographics
NPI:1457359689
Name:ROBERTSON, CANDACE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 HICKORY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-9300
Mailing Address - Country:US
Mailing Address - Phone:865-558-3004
Mailing Address - Fax:
Practice Address - Street 1:137 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37901
Practice Address - Country:US
Practice Address - Phone:865-632-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26937207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3091698Medicaid
TNG04206Medicare UPIN
TN3091698Medicaid