Healthcare Provider Details

I. General information

NPI: 1902196439
Provider Name (Legal Business Name): ROBERT LEE FIELDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOBBY LEE FIELDS D.O.

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2 READS WAY STE 201
NEW CASTLE DE
19720-1607
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-8900
  • Fax: 865-691-0843
Mailing address:
  • Phone: 302-709-4709
  • Fax: 302-709-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2010020944
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number62137
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: