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Individual

ELLIOTT C ROBERTS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
657 SKYLINE DR, JACKSON, TN 38301-3903
(731) 541-8425
(731) 541-8420
Mailing address
657 SKYLINE DR, JACKSON, TN 38301-3903
(731) 541-8425
(731) 541-8420

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD0000043714
TN
207VG0400X
Gynecology Physician
4301048061
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104813136
MI
Enumeration date
04/08/2006
Last updated
03/04/2014
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