Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | L8490 | TX |
NPI | 1184808933 |
---|---|
Provider Name | John Marion Robertson |
First Address | Dallas, TX 75373-3784 |
Second Address | Prosper, TX 75078-9805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 06/04/2021 |