1821002353 NPI number — DAVID W ROBERTSON DPM

Table of content: DAVID W ROBERTSON DPM (NPI 1821002353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821002353 NPI number — DAVID W ROBERTSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
DAVID
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1821002353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 CHANCELLOR DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
CRESTVIEW HILLS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-9900
Provider Business Mailing Address Fax Number:
859-341-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2865 CHANCELLOR DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
CRESTVIEW HILLS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-9900
Provider Business Practice Location Address Fax Number:
859-341-1649
Provider Enumeration Date:
07/28/2006

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: 213ES0131X , with the licence number:  00211 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000176592 . This is a "2ND CENTRAL STATES HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000176592 . This is a "BLUE CROSS BLUE SHIELD PP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2321993 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61131709501 . This is a "BWC CAREWORKS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80002116 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000176592 . This is a "CENTRAL STATES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000176592 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000176592 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2522380002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000176592 . This is a "EXECUTIVE AND EMPLOYEE BE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com