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NPI Code Detail

MEDICARE: DR. PATRICK AARON ROBERTSON M.D.

MEDICARE: DR. PATRICK AARON ROBERTSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician6940AWY
2207X00000XOrthopaedic Surgery Physician153414MA
3207X00000XOrthopaedic Surgery Physician10168NH
4207X00000XOrthopaedic Surgery Physician95-00203NC
5207X00000XOrthopaedic Surgery PhysicianMD14964ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
26940AOTHERWYMEDICAL LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194715037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK AARON ROBERTSON M.D.
Provider Business Mailing Address
First Line : PO BOX 1450
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-1450
Country : US
Telephone Number : 307-358-1403
Fax Number : 307-358-3432
Provider Business Practice Location Address
First Line : 111 S 5TH ST
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-2434
Country : US
Telephone Number : 307-358-2122
Fax Number : 307-358-9216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2005
Last Update Date : 11/05/2013

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1154385748 — MS. REAGAN JANAE SCOTT O.T.R./L.
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1942264122 — MR. CHARLES ROBERT MANGUS P.T.
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