1184646663 NPI number — VALORIE R ROBERTSON M. D.

Table of content: VALORIE R ROBERTSON M. D. (NPI 1184646663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184646663 NPI number — VALORIE R ROBERTSON M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
VALORIE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184646663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULVERDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78163-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-980-2435
Provider Business Mailing Address Fax Number:
830-980-4915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2795 BULVERDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULVERDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78163-2195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-980-2435
Provider Business Practice Location Address Fax Number:
830-980-4915
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J5194 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K0087437 . This is a "TX CONTROLLED SUBSTANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: J5194 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: BR3912296 . This is a "US CONTROLLED SUBSTANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0025DH . This is a "BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080132314 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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