Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D17661 | TX |
NPI | 1013036722 |
---|---|
Provider Name | Dr. Roxanne G Robertson |
First Address | Corpus Christi, TX 78411-4416 |
Second Address | Corpus Christi, TX 78411-4416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |