Healthcare Provider Details

I. General information

NPI: 1598725285
Provider Name (Legal Business Name): PHILIP BRUNNER ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WESTWOOD CMN
BLUEFIELD VA
24605-2031
US

IV. Provider business mailing address

347 SANDPIPER AVE
PRINCETON WV
24740-4185
US

V. Phone/Fax

Practice location:
  • Phone: 276-326-2686
  • Fax:
Mailing address:
  • Phone: 304-425-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15604
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101044622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: