Provider Demographics
NPI:1407840481
Name:ROBERTSON, JOHN BURR JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BURR
Last Name:ROBERTSON
Suffix:JR
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 1:10241 KINGSTON PIKE
Mailing Address - Street 2:SUITE 1 AND 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3240
Mailing Address - Country:US
Mailing Address - Phone:865-691-1165
Mailing Address - Fax:865-690-6042
Practice Address - Street 1:10241 KINGSTON PIKE
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3240
Practice Address - Country:US
Practice Address - Phone:865-691-1165
Practice Address - Fax:865-690-6042
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000214552084P0800X, 2084P0802X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3062194Medicare ID - Type Unspecified
C76407Medicare UPIN