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NPI Code Detail

MEDICARE: JOHN MARION ROBERTSON MD

MEDICARE: JOHN MARION ROBERTSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0214XPediatric Pulmonology PhysicianL8490TX

General Provider Information

NPI Number : 1184808933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MARION ROBERTSON MD
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-6483
Fax Number : 682-885-3113
Provider Business Practice Location Address
First Line : 4200 W UNIVERSITY DR
Second Line :
City : PROSPER
State : TX
Zip : 75078-9805
Country : US
Telephone Number : 682-303-4200
Fax Number : 682-303-4242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2007
Last Update Date : 04/06/2021

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