MEDICARE: GERALD MELVIN ROBERTSON M.D.

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	2084P0800X	Psychiatry Physician	06868R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801894225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD MELVIN ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2540
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71207-2540
Country	:	US
Telephone Number	:	318-388-0810
Fax Number	:	318-388-0810

Provider Business Practice Location Address
First Line	:	904 DEVILLE LN
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-6313
Country	:	US
Telephone Number	:	318-255-5020
Fax Number	:	318-255-6623

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	03/03/2015

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