Provider Demographics
NPI:1609849496
Name:ROBERTSON, TED II (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:ROBERTSON
Suffix:II
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 1:500 HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1492
Mailing Address - Country:US
Mailing Address - Phone:386-252-5858
Mailing Address - Fax:386-252-4477
Practice Address - Street 1:500 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1492
Practice Address - Country:US
Practice Address - Phone:386-252-5858
Practice Address - Fax:386-252-4477
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104386207V00000X
OH35.071420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002343800Medicaid