Provider Demographics
NPI:1942595301
Name:ROBERTSON, MARTIN F (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:F
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9903 SANTA MONICA BLVD
Mailing Address - Street 2:# 4500
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1671
Mailing Address - Country:US
Mailing Address - Phone:405-622-2070
Mailing Address - Fax:
Practice Address - Street 1:9917 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5504
Practice Address - Country:US
Practice Address - Phone:405-622-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2894522363LF0000X
OK112312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG842XMedicare PIN