Basic Information
| Provider Information | |||||||||
| NPI: | 1194715037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1450 | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826331450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073581403 | ||||||||
| FaxNumber: | 3073583432 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 5TH ST | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826332434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582122 | ||||||||
| FaxNumber: | 3073589216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2005 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 6940A | WY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 153414 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 10168 | NH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 95-00203 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD14964 | ME | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1194715037 | 05 | ME | MEDICAID | 6940A | 01 | WY | MEDICAL LICENSE | OTHER | 119905600 | 05 | WY | MEDICAID |