Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 19719 | KY |
Y | 2084N0402X | Child Neurologist | 19719 | KY |
N | 2084N0600X | Clinical Neurophysiologist | 19719 | KY |
NPI | 1275571481 |
---|---|
Provider Name | William C Robertson JR. |
First Address | Lexington, KY 40536-0001 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64197197 | (05) | KY |
C64397 | (02) |