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General NPI Number Information
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NPI Number | 1003278607
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Entity Type | Individual
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Provider Name | CHRISTOPHER VERNON ROBERTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 201 YELLOWSTONE AVE
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City | CODY
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State | WY
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Zip | 82414-9313
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Country | US
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Telephone | 307-527-7561
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W 940 N
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City | PROVO
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State | UT
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Zip | 84604-3301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12261A
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License Number State | WY
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