Individual
MR. TIMOTHY WAYNE ROBERTSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA, CSA
Contact information
Practice address
4427 N VINEYARD MEADOW LN, KATY, TX 77449-3445
(832) 248-8635
Mailing address
4427 N VINEYARD MEADOW LN, KATY, TX 77449-3445
(832) 248-8635
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00487
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA00487
N/A
TX
Enumeration date
07/27/2012
Last updated
06/24/2020
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