MEDICARE: NATHANIEL RICHARD ROBERTSON MD

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
1	207Q00000X	Family Medicine Physician	M0886	TX

General Provider Information

NPI Number	:	1215910575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL RICHARD ROBERTSON MD

Provider Business Mailing Address
First Line	:	5315 FM 1960 RD W
Second Line	:	#244
City	:	HOUSTON
State	:	TX
Zip	:	77069-4410
Country	:	US
Telephone Number	:	832-286-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	SUITE 233
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	832-778-1655
Fax Number	:	832-778-1657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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