Healthcare Provider Details

I. General information

NPI: 1235498940
Provider Name (Legal Business Name): SCOTT ROBERTSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CHAMBERS ST
EUGENE OR
97402-3745
US

IV. Provider business mailing address

1060 CHAMBERS ST
EUGENE OR
97402-3745
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-3373
  • Fax: 541-342-3373
Mailing address:
  • Phone: 541-342-3373
  • Fax: 541-342-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number172371
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: