Provider Demographics
NPI:1184646663
Name:ROBERTSON, VALORIE R (M D)
Entity Type:Individual
Prefix:
First Name:VALORIE
Middle Name:R
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-0038
Mailing Address - Country:US
Mailing Address - Phone:830-980-2435
Mailing Address - Fax:830-980-4915
Practice Address - Street 1:2795 BULVERDE RD
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2195
Practice Address - Country:US
Practice Address - Phone:830-980-2435
Practice Address - Fax:830-980-4915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0087437OtherTX CONTROLLED SUBSTANCE
TXJ5194OtherSTATE LICENSE NUMBER
TXBR3912296OtherUS CONTROLLED SUBSTANCE
TX0025DHOtherBCBS NUMBER
TX080132314OtherRAILROAD MEDICARE
TXJ5194OtherSTATE LICENSE NUMBER
TXK0087437OtherTX CONTROLLED SUBSTANCE