Healthcare Provider Details

I. General information

NPI: 1205824984
Provider Name (Legal Business Name): R. P. SABO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SPARTA ST
MC MINNVILLE TN
37110-1317
US

IV. Provider business mailing address

1524 SPARTA ST
MC MINNVILLE TN
37110-1317
US

V. Phone/Fax

Practice location:
  • Phone: 931-474-4136
  • Fax: 931-474-4137
Mailing address:
  • Phone: 931-474-4136
  • Fax: 931-474-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number40009
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT PATTISON SABO
Title or Position: OWNER
Credential: M.D.
Phone: 931-474-4136