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NPI Code Detail

MEDICARE: DR. JOSEPH KENNETH ROBERTSON MD

MEDICARE: DR. JOSEPH KENNETH 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
1174400000XSpecialist04-13917KS

General Provider Information

NPI Number : 1194798116
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH KENNETH ROBERTSON MD
Provider Business Mailing Address
First Line : 1795 BLUE HERON DR
Second Line :
City : VIERA
State : FL
Zip : 32940-6799
Country : US
Telephone Number : 321-637-3788
Fax Number : 321-637-3568
Provider Business Practice Location Address
First Line : 2900 VETERANS WAY
Second Line :
City : VIERA
State : FL
Zip : 32940-8007
Country : US
Telephone Number : 321-637-3788
Fax Number : 321-637-3568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 07/08/2007

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