Provider Demographics
NPI:1619033925
Name:ROBERTSON, KEITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:696 HAMPSHIRE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2699
Mailing Address - Country:US
Mailing Address - Phone:805-497-0817
Mailing Address - Fax:805-497-8933
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:STE 200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2699
Practice Address - Country:US
Practice Address - Phone:805-497-0817
Practice Address - Fax:805-497-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA07336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703360Medicaid
CAH86538Medicare UPIN
CAWA70336AMedicare PIN