Provider Demographics
NPI:1841288255
Name:MINAHAN, ROBERT EMMETT JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMETT
Last Name:MINAHAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:336 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1844
Mailing Address - Country:US
Mailing Address - Phone:615-346-8182
Mailing Address - Fax:615-829-8970
Practice Address - Street 1:336 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1844
Practice Address - Country:US
Practice Address - Phone:615-346-8182
Practice Address - Fax:615-829-8970
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC342752084N0400X
AZ684472084N0600X
MDD00516652084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC012435M65Medicare PIN
G52075Medicare UPIN