Provider Demographics
NPI:1508828831
Name:DWIGHT L. ROBERSON, M.D. INC.
Entity Type:Organization
Organization Name:DWIGHT L. ROBERSON, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-790-8545
Mailing Address - Street 1:16444 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5422
Mailing Address - Country:US
Mailing Address - Phone:562-790-8545
Mailing Address - Fax:562-790-2433
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:SUITE #208
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:562-790-8545
Practice Address - Fax:562-790-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32654208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G3265400Medicaid
CA0G3265400Medicaid
CAG32654Medicare ID - Type Unspecified