Healthcare Provider Details

I. General information

NPI: 1821002353
Provider Name (Legal Business Name): DAVID W ROBERTSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 CHANCELLOR DR SUITE 205
CRESTVIEW HILLS KY
41017-3931
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 205
CRESTVIEW HILLS KY
41017-3931
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-9900
  • Fax: 859-341-1649
Mailing address:
  • Phone: 859-341-9900
  • Fax: 859-341-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00211
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: