MEDICARE: ROBERT J. POMPHREY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD29910	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD29910	OTHER	TN	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861495152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J. POMPHREY MD

Provider Business Mailing Address
First Line	:	1014 BELL STORE RD
Second Line	:
City	:	GLEASON
State	:	TN
Zip	:	38229-6418
Country	:	US
Telephone Number	:	731-571-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	16615 HIGHWAY 104 N STE B
Second Line	:
City	:	LEXINGTON
State	:	TN
Zip	:	38351-5753
Country	:	US
Telephone Number	:	731-968-0660
Fax Number	:	731-968-0007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/27/2021

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