Provider Demographics
NPI:1467695247
Name:ROBERTSON, ELIZABETH BERTUCCI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BERTUCCI
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:BRANDON
Other - Last Name:BERTUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 PETROLEUM DR
Mailing Address - Street 2:LAFAYETTE
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3880
Mailing Address - Country:US
Mailing Address - Phone:337-988-9999
Mailing Address - Fax:337-984-7003
Practice Address - Street 1:200 PETROLEUM DR
Practice Address - Street 2:LAFAYETTE
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3880
Practice Address - Country:US
Practice Address - Phone:337-988-9999
Practice Address - Fax:337-984-7003
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205346207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology