Provider Demographics
NPI:1710169784
Name:ROBERTSON, CHRISTOPHER S (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4761
Mailing Address - Country:US
Mailing Address - Phone:904-269-0500
Mailing Address - Fax:904-269-9805
Practice Address - Street 1:930 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4761
Practice Address - Country:US
Practice Address - Phone:904-269-0500
Practice Address - Fax:904-269-9805
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL600-51723OtherBCBS OF AL
AL600-51724OtherBCBS OF AL
GA511I970133Medicare PIN
GAP00463021Medicare PIN