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NPI Code Detail

MEDICARE: DEIRDRE ROBERTSON CST

MEDICARE: DEIRDRE ROBERTSON CST
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
1246ZS0410XSurgical Technologist

General Provider Information

NPI Number : 1700288560
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIRDRE ROBERTSON CST
Provider Business Mailing Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-264-2600
Fax Number :
Provider Business Practice Location Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-264-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 09/23/2014

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Directions to “ DEIRDRE ROBERTSON CST” Practice Location

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