Healthcare Provider Details

I. General information

NPI: 1982847786
Provider Name (Legal Business Name): CAROL F ROBERTSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 HUEBNER RD STE 260
SAN ANTONIO TX
78240-1545
US

IV. Provider business mailing address

9150 HUEBNER RD STE 260
SAN ANTONIO TX
78240-1545
US

V. Phone/Fax

Practice location:
  • Phone: 210-561-1551
  • Fax: 210-561-0552
Mailing address:
  • Phone: 210-561-1551
  • Fax: 210-561-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ1771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: