Individual
CHARLES PAUL ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5658 HIGHWAY 260, SUITE 24, LAKESIDE, AZ 85929-5189
(928) 537-4379
(928) 537-4653
Mailing address
5423 BLACK BEAR WAY, LAKESIDE, AZ 85929-5514
(928) 368-5493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11095
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203406
—
AZ
Enumeration date
01/30/2006
Last updated
02/27/2014
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