Healthcare Provider Details

I. General information

NPI: 1932322989
Provider Name (Legal Business Name): DAVID PERRY ROBERGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 N LAUDERDALE ST
MEMPHIS TN
38105-2729
US

IV. Provider business mailing address

332 N LAUDERDALE ST MS 515
MEMPHIS TN
38105-2729
US

V. Phone/Fax

Practice location:
  • Phone: 901-495-3006
  • Fax: 901-495-3842
Mailing address:
  • Phone: 901-495-3006
  • Fax: 901-495-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number36125
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: