Healthcare Provider Details

I. General information

NPI: 1447307871
Provider Name (Legal Business Name): DONALD JACK ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 9TH ST STE 260
LUBBOCK TX
79415-3300
US

IV. Provider business mailing address

5219 CITY BANK PKWY SUITE 135
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-8185
  • Fax: 806-792-9180
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberF7107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: