Provider Demographics
NPI:1396751749
Name:JANTZ, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:JANTZ
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 1:706 CADET COURT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
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
Practice Address - Country:US
Practice Address - Phone:615-449-2472
Practice Address - Fax:615-449-4709
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD018858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033985Medicaid
TN3033985Medicaid
3033985Medicare ID - Type Unspecified