Provider Demographics
NPI:1578551354
Name:ROBERTSON, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
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 1:1110 W MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-2423
Mailing Address - Country:US
Mailing Address - Phone:419-424-1393
Mailing Address - Fax:419-424-3424
Practice Address - Street 1:1110 W MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-2423
Practice Address - Country:US
Practice Address - Phone:419-424-1393
Practice Address - Fax:419-424-3424
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032598207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340965Medicaid
OH000000130136OtherBLUE CROSS BLUE SHIELD NO
OH0340965Medicaid
OH000000130136OtherBLUE CROSS BLUE SHIELD NO