Provider Demographics
NPI:1124657747
Name:ROBERTSON, CASSANDRA LOU (DO)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LOU
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2609
Mailing Address - Country:US
Mailing Address - Phone:812-996-7474
Mailing Address - Fax:812-996-7508
Practice Address - Street 1:751 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2609
Practice Address - Country:US
Practice Address - Phone:812-996-7474
Practice Address - Fax:812-996-7508
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02006454A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program