Healthcare Provider Details

I. General information

NPI: 1821046715
Provider Name (Legal Business Name): CLIFFORD WILLIAM ROBERSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLIFFORD W ROBERSON JR. MD

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 JACKSON AVE
POINT PLEASANT WV
25550-1717
US

IV. Provider business mailing address

3009 JACKSON AVE PO BOX 601
POINT PLEASANT WV
25550-1717
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-8095
  • Fax: 304-675-8096
Mailing address:
  • Phone: 304-675-8095
  • Fax: 304-675-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number22760
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: