Provider Demographics
NPI:1679582530
Name:WILLIAM G ROBERTSON MD PA
Entity type:Organization
Organization Name:WILLIAM G ROBERTSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:512-418-1755
Mailing Address - Street 1:4106 MEDICAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-418-1755
Mailing Address - Fax:512-418-1010
Practice Address - Street 1:4106 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-418-1755
Practice Address - Fax:512-418-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9636208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141127OtherAETNA
A36146Medicare UPIN
TX00F91KMedicare PIN