Provider Demographics
NPI:1497778385
Name:ROBERTSON, ROBERT FORBES (M D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FORBES
Last Name:ROBERTSON
Suffix:
Gender:M
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 1:17075 DEVONSHIRE ST.
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5408
Mailing Address - Country:US
Mailing Address - Phone:818-366-2977
Mailing Address - Fax:818-360-3533
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:SUITE # 205
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-366-2977
Practice Address - Fax:818-360-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25716207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A257160Medicaid
CAA83273Medicare UPIN