Provider Demographics
NPI:1801895974
Name:ROBERTSON, DANIEL TODD (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TODD
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:935 MICA DR
Practice Address - Street 2:SUITE 13
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7268
Practice Address - Country:US
Practice Address - Phone:775-783-3065
Practice Address - Fax:775-267-1829
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84436207XS0106X, 207XX0005X
NV10288207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36820Medicare PIN
NV2013265Medicaid
CABF842YMedicare PIN
H71408Medicare UPIN
CABF842ZMedicare PIN