# TRI-CITIES PEDIATRIC ENDOCRINOLOGY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851721369
- **Authorized official:** DR. MARY GWYN ROPER M.D., F.A.A.P. (OWNER)
- **Authorized official phone:** (423) 483-0828

## Contact information

- **Practice address:** 140 OLD GRAY STATION RD, SUITE 200, GRAY, TN 37615-3612
- **Practice address phone:** (423) 483-0828
- **Practice address fax:** (423) 546-4103
- **Mailing address:** PO BOX 3343, JOHNSON CITY, TN 37602-3343
- **Mailing address phone:** (423) 483-0828
- **Mailing address fax:** (423) 546-4103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 37128 | TN | Yes |

## Other

- **Enumeration date:** 11/19/2013
- **Last updated:** 02/05/2015