Provider Demographics
NPI:1699359927
Name:ROBERTSON, BRITTON GREGORY
Entity Type:Individual
Prefix:
First Name:BRITTON
Middle Name:GREGORY
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6333
Mailing Address - Country:US
Mailing Address - Phone:161-840-6986
Mailing Address - Fax:
Practice Address - Street 1:124 S LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-6333
Practice Address - Country:US
Practice Address - Phone:618-406-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health