Healthcare Provider Details

I. General information

NPI: 1861495152
Provider Name (Legal Business Name): ROBERT J. POMPHREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16615 HIGHWAY 104 N STE B
LEXINGTON TN
38351-5753
US

IV. Provider business mailing address

1014 BELL STORE RD
GLEASON TN
38229-6418
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-0660
  • Fax: 731-968-0007
Mailing address:
  • Phone: 731-571-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29910
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: