Provider Demographics
NPI:1184720567
Name:ROBERSON, FRED MCRAE (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:MCRAE
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17453 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-7288
Mailing Address - Country:US
Mailing Address - Phone:507-732-5843
Mailing Address - Fax:507-233-1680
Practice Address - Street 1:1202 5TH GRANT BLVD
Practice Address - Street 2:LAKE CITY MEDICAL CENTER
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1042
Practice Address - Country:US
Practice Address - Phone:651-565-4571
Practice Address - Fax:651-565-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-12-23
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Provider Licenses
StateLicense IDTaxonomies
MN33927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB61029Medicare UPIN