Provider Demographics
NPI:1154345031
Name:ROBERTSON, WESLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:J
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 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4338
Mailing Address - Country:US
Mailing Address - Phone:702-363-3000
Mailing Address - Fax:702-363-3161
Practice Address - Street 1:7455 W WASHINGTON AVE
Practice Address - Street 2:STE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4338
Practice Address - Country:US
Practice Address - Phone:702-363-3000
Practice Address - Fax:703-363-3161
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7487208000000X
CAG75292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019564Medicaid