Provider Demographics
NPI:1700955689
Name:ROBERTSON, AMY NEUHOFF (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NEUHOFF
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NEUHOFF
Other - Last Name:RAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13209 COUNTRY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1901
Mailing Address - Country:US
Mailing Address - Phone:512-266-2322
Mailing Address - Fax:512-266-2322
Practice Address - Street 1:12171 W PARMER LN
Practice Address - Street 2:STE 201
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7361
Practice Address - Country:US
Practice Address - Phone:512-528-1144
Practice Address - Fax:512-528-1143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4213207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52755Medicare UPIN