Individual
DR. RANDOLPH HARLEN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4969
Mailing address
142 W 5TH ST, COOKEVILLE, TN 38501-1760
(931) 528-2541
(931) 526-8814
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18129
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050269
—
OH
05
—
201023920
—
IN
01
—
300114288
RAILROAD MEDICARE
TN
05
—
3037577
—
TN
01
—
3156107
BCBS
TN
Enumeration date
07/14/2006
Last updated
02/15/2016
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