MEDICARE: MATTHEW BRUCE ROBERSON 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	207Q00000X	Family Medicine Physician	L4677	TX
2	207Q00000X	Family Medicine Physician	18436	NV

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871590570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BRUCE ROBERSON MD

Provider Business Mailing Address
First Line	:	1151 S NEVADA HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-8900
Fax Number	:	757-279-4527

Provider Business Practice Location Address
First Line	:	1151 S NEVADA HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-8900
Fax Number	:	775-727-9452

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2019

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