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NPI Code Detail

MEDICARE: DR. SUSAN J ROBERTSON M.D.

MEDICARE: DR. SUSAN J 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
1207Q00000XFamily Medicine Physician30342CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2R37418OTHERCOBC/BS

General Provider Information

NPI Number : 1780618678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN J ROBERTSON M.D.
Provider Business Mailing Address
First Line : 583 W SAGEBRUSH CT
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-1644
Country : US
Telephone Number : 303-666-8284
Fax Number :
Provider Business Practice Location Address
First Line : 1420 W MIDWAY BLVD
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-2090
Country : US
Telephone Number : 303-466-1866
Fax Number : 303-466-4081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 01/14/2011

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