Provider Demographics
NPI:1194720342
Name:ROBERTSON, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4130 DUTCHMANS LN
Mailing Address - Street 2:STE 400
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4711
Mailing Address - Country:US
Mailing Address - Phone:502-897-0697
Mailing Address - Fax:502-897-0658
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4711
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0700074OtherUNITED HEALTHCARE
KY160032460OtherRAILROAD
KY0406000000044471OtherBLUE CROSS/BLUE SHIELD
KY610673930GOtherHUMANA
KYEMPLOYER'S IDOther610673930
KY6420738400Medicaid
KY1048738OtherPASSPORT
KY0406000000044471OtherBLUE CROSS/BLUE SHIELD
KY1267806Medicare ID - Type UnspecifiedMEDICARE