Provider Demographics
NPI:1831465822
Name:ROBERTSON, JERE CALVIN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERE
Middle Name:CALVIN
Last Name:ROBERTSON
Suffix:SR
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 1:608 DEEPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1226
Mailing Address - Country:US
Mailing Address - Phone:270-886-7352
Mailing Address - Fax:
Practice Address - Street 1:608 DEEPWOOD DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1226
Practice Address - Country:US
Practice Address - Phone:270-886-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13182207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology