Provider Demographics
NPI:1053545525
Name:ROBERTSON, WILLIAM E (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3345
Mailing Address - Country:US
Mailing Address - Phone:509-965-1770
Mailing Address - Fax:509-966-4209
Practice Address - Street 1:4001 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3345
Practice Address - Country:US
Practice Address - Phone:509-965-1770
Practice Address - Fax:509-966-4209
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013484208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice