MEDICARE: DWAIN 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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	90418	GA
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	Q9896	TX

General Provider Information

NPI Number	:	1871913111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAIN ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	2820 MCKINNON ST APT 2106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1057
Country	:	US
Telephone Number	:	301-828-5904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 GAYLORD PKWY STE 830
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9419
Country	:	US
Telephone Number	:	469-800-5720
Fax Number	:

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	06/12/2026

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