Provider Demographics
NPI:1124270277
Name:ROBERTSON, BRIAN ARTHUR (MS, PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2776 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1810
Mailing Address - Country:US
Mailing Address - Phone:909-593-7437
Mailing Address - Fax:909-593-1958
Practice Address - Street 1:2776 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1810
Practice Address - Country:US
Practice Address - Phone:909-593-7437
Practice Address - Fax:909-593-1958
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA151001363A00000X
CAPA19914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant