Provider Demographics
NPI:1841386570
Name:ROBERTSON, JEFFREY BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 N BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4113
Mailing Address - Country:US
Mailing Address - Phone:214-416-8100
Mailing Address - Fax:214-416-8199
Practice Address - Street 1:1114 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4113
Practice Address - Country:US
Practice Address - Phone:214-416-8100
Practice Address - Fax:214-416-8199
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H35702Medicare UPIN
H35702Medicare UPIN
2540396OtherAETNA PPO
TX8F3290OtherBCBS PROVIDER ID
UNITED HEALTHCAREOther751622524
TX8F9503Medicare PIN
TX0016DQOtherBCBS GROUP
TX8F9499Medicare PIN
TX180043505OtherMEDICARE RR ELLIS COUNTY
TX143345007Medicaid
TX180043236OtherMEDICARE RR DALLAS COUNTY
TX143345006Medicaid
7282266OtherAETNA HMO
7282266OtherAETNA POS
TX0350890002Medicare NSC