Healthcare Provider Details

I. General information

NPI: 1831175801
Provider Name (Legal Business Name): ROBERT F PHLEGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 28 GRANDVIEW MEDICAL CENTER
JASPER TN
37347-3638
US

IV. Provider business mailing address

617 MISSISSIPPI AVE
SIGNAL MOUNTAIN TN
37377-2297
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-9500
  • Fax:
Mailing address:
  • Phone: 423-886-5385
  • Fax: 423-836-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number07139
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: