Provider Demographics
NPI:1487610481
Name:ALBERTSON, ROBERT DURFFEE III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DURFFEE
Last Name:ALBERTSON
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 1:900 E MICHIGAN AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2490
Mailing Address - Country:US
Mailing Address - Phone:517-782-3190
Mailing Address - Fax:
Practice Address - Street 1:900 E MICHIGAN AVE
Practice Address - Street 2:STE 105
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2490
Practice Address - Country:US
Practice Address - Phone:517-782-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046296207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI290007970OtherRR MEDICARE
MI103112682Medicaid
MIM09200001Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MI103112682Medicaid
MIN53130019Medicare UPIN