Provider Demographics
NPI:1649232448
Name:ROBERTSON, CARLEY C (MD)
Entity type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:F
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:PO BOX 2113
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-2113
Mailing Address - Country:US
Mailing Address - Phone:406-265-1840
Mailing Address - Fax:
Practice Address - Street 1:1412 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5106
Practice Address - Country:US
Practice Address - Phone:406-265-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5023207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT080096621OtherMEDICARE RAILROAD
MT000000641OtherBCBS NMH GROUP NUMBER
MT1649232448Medicaid
MT1649232448Medicaid
000071734Medicare PIN