Healthcare Provider Details

I. General information

NPI: 1831161082
Provider Name (Legal Business Name): GERALD ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES 2111 COLLEGE DRIVE
GALLUP NM
87301
US

IV. Provider business mailing address

REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES 1901 RED ROCK DRIVE
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-1820
  • Fax:
Mailing address:
  • Phone: 505-863-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number72-73
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: