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General NPI Number Information
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NPI Number | 1447307871
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Entity Type | Individual
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Provider Name | DONALD JACK ROBERTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 3502 9TH ST STE 260
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City | LUBBOCK
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State | TX
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Zip | 79415-3300
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Country | US
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Telephone | 806-792-8185
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Fax | 806-792-9180
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Provider Business Mailing Address
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Address Line | 5219 CITY BANK PKWY SUITE 135
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City | LUBBOCK
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State | TX
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Zip | 79407-3544
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Country | US
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Telephone | 806-761-0334
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Fax | 806-782-0097
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | F7107
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License Number State | TX
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