Provider Demographics
NPI:1821059478
Name:ROBERTSON, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5464
Practice Address - Street 1:700 24TH AVE, NW
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5464
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK25018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G8411OtherBLUE SHIELD
TXG83169Medicare UPIN
TX080191302OtherRR/MEDICARE
TX1031007-03Medicaid
TX1031007-04OtherCSHCN
TX1031007-03Medicaid