Healthcare Provider Details

I. General information

NPI: 1861579989
Provider Name (Legal Business Name): ROBERT PAUL UNKEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MOUNTAIN VIEW DR STE 300
VONORE TN
37885-2666
US

IV. Provider business mailing address

125 MOUNTAIN VIEW DR STE 300
VONORE TN
37885-2666
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-2971
  • Fax: 423-884-2984
Mailing address:
  • Phone: 423-884-2971
  • Fax: 423-884-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35046
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35046
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: