Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PL 60088829 | WA |
N | 213ES0000X | Sports Medicine | PL 60088829 | WA |
Y | 213ES0103X | Foot & Ankle Surgery | E4976 | CA |
N | 213ES0103X | Foot & Ankle Surgery | PL 60088829 | WA |
NPI | 1235458027 |
---|---|
Provider Name | Dr. Jeffrey Robertson |
First Address | Fontana, CA 92335-6720 |
Second Address | Fontana, CA 92335-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 01/12/2021 |