Provider Demographics
NPI:1124067947
Name:ROBERTSON, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6248
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-6248
Mailing Address - Country:US
Mailing Address - Phone:806-771-5550
Mailing Address - Fax:806-771-5544
Practice Address - Street 1:3801 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3859
Practice Address - Country:US
Practice Address - Phone:806-771-5550
Practice Address - Fax:806-771-5544
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132160604Medicaid
TX132160604Medicaid
TX8049M4Medicare PIN