Provider Demographics
NPI:1629166517
Name:ROBERTSON, CHRISTOPHER KENT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KENT
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 1:17198 ST LUKE'S WAY
Mailing Address - Street 2:MAC 1 BLDG, SUITE 650
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8011
Mailing Address - Country:US
Mailing Address - Phone:936-321-2200
Mailing Address - Fax:936-321-5041
Practice Address - Street 1:17198 ST LUKES WAY
Practice Address - Street 2:MAC 1 BLDG, SUITE 650
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8011
Practice Address - Country:US
Practice Address - Phone:936-321-2200
Practice Address - Fax:936-321-5041
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL5886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156706701Medicaid
TX156706701Medicaid
GA80192951Medicare PIN
TXH77038Medicare UPIN