MEDICARE: DR. MATTHEW LEE 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
1	207Y00000X	Otolaryngology Physician	44300	CO

General Provider Information

NPI Number	:	1245208214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW LEE ROBERTSON MD

Provider Business Mailing Address
First Line	:	5421 NORTHERN LIGHTS DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-4439
Country	:	US
Telephone Number	:	970-377-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 E ELIZABETH ST
Second Line	:	#F-101
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4044
Country	:	US
Telephone Number	:	970-221-1177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/05/2012

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