Provider Demographics
NPI:1215018510
Name:ROBERTSON, DANIEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S.E.18TH AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8211
Mailing Address - Country:US
Mailing Address - Phone:352-622-3360
Mailing Address - Fax:352-671-3269
Practice Address - Street 1:1901 S.E.18TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8211
Practice Address - Country:US
Practice Address - Phone:352-622-3360
Practice Address - Fax:352-671-3269
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069431207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378829600Medicaid
FLF82195Medicare UPIN
FL27977Medicare PIN