Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD8612 | TN |
NPI | 1013919075 |
---|---|
Provider Name | Dr. Samuel Gwin Robbins JR. |
First Address | Germantown, TN 38138-3957 |
Second Address | Germantown, TN 38138-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106803001 | (05) | AR |
153038 | UNISON TENNCARE (01) | TN |
201906401 | (05) | MO |
3092503 | BCBS OF TN (01) | TN |
3191899 | (05) | TN |
3906 | TLC TENNCARE (01) | TN |
D32191 | (02) |