Provider Demographics
NPI:1972579605
Name:LONERGAN, ROBERT P III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:LONERGAN
Suffix:III
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 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-767-8662
Practice Address - Fax:901-767-8666
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38131207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371161Medicaid
TN3889622Medicaid
MS07187860Medicaid
TN5976219OtherCIGNA
TN620819926OtherCIGNA
TN4179729OtherBCBS
TN620819926OtherAETNA
TN00001072832 15OtherUNITED HEALTHCARE
TN7239223OtherAETNA
TNP00618041OtherRAILROAD MEDICARE
MS9025301Medicaid
MS07187860Medicaid
TN5976219OtherCIGNA
TN4179729OtherBCBS
TN0723280003Medicare NSC
TN620819926OtherAETNA
TN0723280010Medicare NSC
TN3371161Medicare PIN