MEDICARE: KEARY ROBERT WILLIAMS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD41529	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912958059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEARY ROBERT WILLIAMS JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 52948
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37950-2948
Country	:	US
Telephone Number	:	865-306-5675
Fax Number	:	865-584-7712

Provider Business Practice Location Address
First Line	:	9430 PARK WEST BLVD STE 310
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4203
Country	:	US
Telephone Number	:	865-694-9676
Fax Number	:	865-588-3742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/29/2019

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