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Organization
SCOTT ROBERTSON MD INC
Active
Organization
SCOTT ROBERTSON MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT E ROBERTSON MD (PRESIDENT)
(805) 489-2205
Entity
Organization
Contact information
Practice address
901 OAK PARK BLVD, SUITE 100, PISMO BEACH, CA 93449-3408
(805) 489-2205
(805) 489-2206
Mailing address
PO BOX 9, PISMO BEACH, CA 93448-0009
(805) 489-2205
(805) 489-2206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2006808
CLIA WAIVER
CA
01
—
C3228143
CA DEPT OF CORPORATIONS NUMBER
CA
01
—
CLP00339667
DPH CLINICAL LABORATORY REGISTRATION NUMBER
CA
Enumeration date
10/19/2009
Last updated
12/20/2011
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