Provider Demographics
NPI:1720013519
Name:ROBERTSON, DANIEL B (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
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:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 NW HIGHWAY 101 STE A
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-3241
Practice Address - Country:US
Practice Address - Phone:541-996-7480
Practice Address - Fax:541-557-6439
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-1941207X00000X
ORMD192188207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205619-02Medicaid
TXA37463Medicare UPIN
TX8B2291Medicare PIN
TX4250250001Medicare NSC