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NPI Code Detail

MEDICARE: DR. SCOTT E ROBERTSON MD

MEDICARE: DR. SCOTT E 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
1207Q00000XFamily Medicine PhysicianA81709CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17202506OTHERCAAETNA PIN
200A817090OTHERCABLUE SHIELD OF CALIFORNIA
3A81709OTHERCABLUE CROSS

General Provider Information

NPI Number : 1811970437
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT E ROBERTSON MD
Provider Business Mailing Address
First Line : 504 PLAZA DR
Second Line :
City : SANTA MARIA
State : CA
Zip : 93454-6917
Country : US
Telephone Number : 805-739-3474
Fax Number :
Provider Business Practice Location Address
First Line : 877 OAK PARK BLVD
Second Line :
City : PISMO BEACH
State : CA
Zip : 93449-3292
Country : US
Telephone Number : 805-474-8450
Fax Number : 805-474-8454
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 03/22/2017

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