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Individual
MR. EARL ROBERTSON
Active
Individual
MR. EARL ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP, LPO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
LO 58
TN
224P00000X
Prosthetist
Primary
LP 49
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP 1357
ABC
—
Enumeration date
04/13/2017
Last updated
04/13/2017
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