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NPI Code Detail

MEDICARE: RICHARD K ROBERTSON JR. MD

MEDICARE: RICHARD K ROBERTSON JR. 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1942943063
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD K ROBERTSON JR. MD
Provider Business Mailing Address
First Line : 100 N ONEIDA ST
Second Line :
City : APPLETON
State : WI
Zip : 54911-4733
Country : US
Telephone Number : 920-832-2783
Fax Number :
Provider Business Practice Location Address
First Line : 100 N ONEIDA ST
Second Line :
City : APPLETON
State : WI
Zip : 54911-4733
Country : US
Telephone Number : 920-832-2783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2022
Last Update Date : 03/21/2026

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