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General NPI Number Information
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NPI Number | 1407870520
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Entity Type | Individual
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Provider Name | DEBORAH G ROBERTSON MD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DRIVE
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City | KETCHUM
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State | ID
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Zip | 83340-6280
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Country | US
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Telephone | 208-727-8100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100 ST. LUKE'S WOOD RIVER MEDICAL CENTER
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City | KETCHUM
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State | ID
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Zip | 83340-0100
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Country | US
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Telephone | 208-727-8100
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD23169
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | M-10641
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License Number State | ID
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