Provider Demographics
NPI:1780112276
Name:ROBERTSON, BRENT JUSTIN (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JUSTIN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18450 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4404
Mailing Address - Country:US
Mailing Address - Phone:281-446-6656
Mailing Address - Fax:281-446-6657
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 365
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2889
Practice Address - Country:US
Practice Address - Phone:936-207-2566
Practice Address - Fax:936-207-2586
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2024-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA115000002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery