Provider Demographics
NPI:1851585517
Name:SILMON, ROBERT W JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SILMON
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 1:2204 PAVILION DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4657
Mailing Address - Country:US
Mailing Address - Phone:423-224-3900
Mailing Address - Fax:423-224-3901
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 310
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-224-3900
Practice Address - Fax:423-224-3901
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN46757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4290096OtherBCBS
TN1522872Medicaid
TN4290096OtherBCBS