Healthcare Provider Details

I. General information

NPI: 1295969640
Provider Name (Legal Business Name): WILLIAM DENNY ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 EAST WASHINGTON ST SUITE 301
MEDINA OH
44256-3332
US

IV. Provider business mailing address

722 SOUTH COURT ST
MEDINA OH
44256-2802
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-8441
  • Fax: 330-725-8442
Mailing address:
  • Phone: 330-725-0977
  • Fax: 330-725-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-031038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: