MEDICARE: DR. JOHN A. 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	207Q00000X	Family Medicine Physician	25018	OK

General Provider Information

NPI Number	:	1821059478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A. ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE
Second Line	:	SUITE 280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5556
Country	:	US
Telephone Number	:	405-364-0555
Fax Number	:	405-573-5464

Provider Business Practice Location Address
First Line	:	700 24TH AVE, NW
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73069
Country	:	US
Telephone Number	:	405-364-0555
Fax Number	:	405-573-5464

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/15/2018

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