Healthcare Provider Details

I. General information

NPI: 1912958059
Provider Name (Legal Business Name): KEARY ROBERT WILLIAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 310
KNOXVILLE TN
37923-4203
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-694-9676
  • Fax: 865-588-3742
Mailing address:
  • Phone: 865-306-5675
  • Fax: 865-584-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD41529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: