Provider Demographics
NPI:1669469961
Name:ROBERTSON, JAMES SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
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 1:2449 HOSPITAL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2399
Mailing Address - Country:US
Mailing Address - Phone:318-212-7840
Mailing Address - Fax:318-212-7945
Practice Address - Street 1:2449 HOSPITAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2399
Practice Address - Country:US
Practice Address - Phone:318-212-7840
Practice Address - Fax:318-212-7945
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13566R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430366Medicaid
LA5H437Medicare PIN
LA5H437CS96Medicare PIN