Provider Demographics
NPI:1720067432
Name:ROBERTSON, TIMOTHY SCOT (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOT
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SPRING BASKET TRL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4991
Mailing Address - Country:US
Mailing Address - Phone:702-525-0911
Mailing Address - Fax:
Practice Address - Street 1:26 SPRING BASKET TRL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77389
Practice Address - Country:US
Practice Address - Phone:702-525-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7832207P00000X
TXN3274207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261260700Medicaid
FL58716OtherBCBS
FLE4376VMedicare ID - Type Unspecified
FLE4376WMedicare ID - Type Unspecified
H21783Medicare UPIN