Provider Demographics
NPI:1831161082
Name:ROBERTSON, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
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:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Mailing Address - Street 2:1901 RED ROCK DRIVE
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-863-7000
Mailing Address - Fax:
Practice Address - Street 1:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Practice Address - Street 2:2111 COLLEGE DRIVE
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM72-73207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
85031326887301A017OtherCHAMPUS
NM10002106OtherLOVELACE HEALTH/SALUD
NMNM002282OtherBCBS
NM09431Medicaid
NMPROVP15197OtherMOLINA
AZ228727Medicaid
NM10002106OtherLOVELACE HEALTH/SALUD