Provider Demographics
NPI:1194715037
Name:ROBERTSON, PATRICK AARON (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:AARON
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 1450
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1450
Mailing Address - Country:US
Mailing Address - Phone:307-358-1403
Mailing Address - Fax:307-358-3432
Practice Address - Street 1:111 S 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2434
Practice Address - Country:US
Practice Address - Phone:307-358-2122
Practice Address - Fax:307-358-9216
Is Sole Proprietor?:No
Enumeration Date:2005-10-23
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6940A207X00000X
MA153414207X00000X
NH10168207X00000X
NC95-00203207X00000X
MEMD14964207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1194715037Medicaid
WY6940AOtherMEDICAL LICENSE
WY119905600Medicaid
WY6940AOtherMEDICAL LICENSE
ME1194715037Medicaid