Basic Information
| Provider Information | |||||||||
| NPI: | 1255355277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAUTH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6298885175 | ||||||||
| FaxNumber: | 6298885176 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 SAUNDERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370758967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6298885175 | ||||||||
| FaxNumber: | 6298885176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00038880 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 52175 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q014327 | 05 | TN | MEDICAID | 10308I9045 | 01 | TN | TN MEDICARE | OTHER |