MEDICARE: DR. JOHN DOUGLAS 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	174400000X	Specialist	24023	AL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	24023	AL

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
2	051515857	OTHER	AL	BLUE CROSS BLUE SHIELD
3	15857	OTHER	AL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1841250156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DOUGLAS ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	6727 TAYLOR COURT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7708
Country	:	US
Telephone Number	:	334-284-2800
Fax Number	:	334-284-0438

Provider Business Practice Location Address
First Line	:	6727 TAYLOR COURT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7708
Country	:	US
Telephone Number	:	334-284-2800
Fax Number	:	334-284-0438

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	12/21/2011

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