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Individual

JACK T ROBERTS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
907 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5015
(865) 980-4897
(865) 977-4793
Mailing address
103 W BROADWAY AVE, MARYVILLE, TN 37801-4703
(865) 273-1752
(865) 273-1755

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
09957
TN
208M00000X
Hospitalist Physician
Primary
MD09957
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3161933
TN
Enumeration date
06/10/2006
Last updated
05/12/2017
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