MEDICARE: DR. DANIEL TODD 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	207XS0106X	Orthopaedic Hand Surgery Physician	G84436	CA
2	207XS0106X	Orthopaedic Hand Surgery Physician	10288	NV

General Provider Information

NPI Number	:	1801895974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL TODD ROBERTSON MD

Provider Business Mailing Address
First Line	:	1111 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6207
Country	:	US
Telephone Number	:	530-543-5659
Fax Number	:	530-541-8723

Provider Business Practice Location Address
First Line	:	935 MICA DR
Second Line	:	SUITE 13
City	:	CARSON CITY
State	:	NV
Zip	:	89705-7268
Country	:	US
Telephone Number	:	775-783-3065
Fax Number	:	775-267-1829

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/16/2014

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