Provider Demographics
NPI:1154388106
Name:ROBERTSON, BRISON O III (MD)
Entity type:Individual
Prefix:
First Name:BRISON
Middle Name:O
Last Name:ROBERTSON
Suffix:III
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 1:35 COVEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1010
Mailing Address - Country:US
Mailing Address - Phone:828-251-5829
Mailing Address - Fax:
Practice Address - Street 1:41 OAKLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4820
Practice Address - Country:US
Practice Address - Phone:828-252-8885
Practice Address - Fax:828-252-9420
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE16443Medicare UPIN
NC209961AMedicare PIN