Individual
DERRICK SCOTT ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13330 USF LAUREL DRIVE, TAMPA, FL 33612-6601
(813) 974-3541
(813) 974-9145
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME113374
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007186600
—
FL
01
—
14NQ3
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/27/2008
Last updated
04/05/2021
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