Provider Demographics
NPI:1215910575
Name:ROBERTSON, NATHANIEL RICHARD (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RICHARD
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 1:5315 FM 1960 RD W
Mailing Address - Street 2:#244
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4410
Mailing Address - Country:US
Mailing Address - Phone:832-286-6070
Mailing Address - Fax:
Practice Address - Street 1:2656 SOUTH LOOP W
Practice Address - Street 2:SUITE 233
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2664
Practice Address - Country:US
Practice Address - Phone:832-778-1655
Practice Address - Fax:832-778-1657
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine