Provider Demographics
NPI:1821002353
Name:ROBERTSON, DAVID W (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 CHANCELLOR DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-341-9900
Mailing Address - Fax:859-341-1649
Practice Address - Street 1:2865 CHANCELLOR DR
Practice Address - Street 2:SUITE 205
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3931
Practice Address - Country:US
Practice Address - Phone:859-341-9900
Practice Address - Fax:859-341-1649
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00211213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000176592Other2ND CENTRAL STATES HEALTH
000000176592OtherBLUE CROSS BLUE SHIELD PP
2321993OtherAETNA
61131709501OtherBWC CAREWORKS
KY80002116Medicaid
000000176592OtherCENTRAL STATES
000000176592OtherBLUE CROSS BLUE SHIELD
000000176592OtherEMPIRE BLUE CROSS BLUE SH
2522380002OtherCIGNA
000000176592OtherEXECUTIVE AND EMPLOYEE BE
000000176592OtherCENTRAL STATES
61131709501OtherBWC CAREWORKS
2321993OtherAETNA
KY4111020001Medicare NSC
KY8787Medicare PIN
000000176592Other2ND CENTRAL STATES HEALTH
000000176592OtherBLUE CROSS BLUE SHIELD
U34576Medicare UPIN
KY8788Medicare PIN
KY2017501Medicare PIN