Provider Demographics
NPI:1356337570
Name:ROBERTSON, BRIAN C (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5906
Mailing Address - Country:US
Mailing Address - Phone:805-922-1739
Mailing Address - Fax:805-922-4197
Practice Address - Street 1:1400E CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:805-739-3100
Practice Address - Fax:805-739-3060
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43271207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G432710Medicaid
CA00G432710Medicaid
CAWG43271BMedicare PIN