Provider Demographics
NPI:1699098699
Name:DONALD W. ROBERTSON, D.O., P.A.
Entity type:Organization
Organization Name:DONALD W. ROBERTSON, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-474-8154
Mailing Address - Street 1:2828 S MCCALL RD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-7791
Mailing Address - Country:US
Mailing Address - Phone:941-474-8154
Mailing Address - Fax:941-473-3583
Practice Address - Street 1:2828 S MCCALL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7791
Practice Address - Country:US
Practice Address - Phone:941-474-8154
Practice Address - Fax:941-473-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578528683OtherINDIVIDUAL NPI
FL1578528683OtherINDIVIDUAL NPI