Provider Demographics
NPI:1104096288
Name:ROBERT J JANTZ
Entity type:Organization
Organization Name:ROBERT J JANTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-449-2472
Mailing Address - Street 1:706 CADET CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2649
Mailing Address - Country:US
Mailing Address - Phone:615-449-2472
Mailing Address - Fax:615-449-4709
Practice Address - Street 1:706 CADET CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2649
Practice Address - Country:US
Practice Address - Phone:615-449-2472
Practice Address - Fax:615-449-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376065Medicare PIN