Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2006018426 | MO |
Y | 207Q00000X | Family Doctor | 2006018426 | MO |
NPI | 1407070816 |
---|---|
Provider Name | Dr. Jerri Dawn Robertson |
First Address | Versailles, MO 65084-1784 |
Second Address | Versailles, MO 65084-1784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 07/06/2012 |