Provider Demographics
NPI:1295969640
Name:ROBERTSON, WILLIAM DENNY (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DENNY
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 1:722 SOUTH COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2802
Mailing Address - Country:US
Mailing Address - Phone:330-725-0977
Mailing Address - Fax:330-725-0977
Practice Address - Street 1:970 EAST WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-725-8441
Practice Address - Fax:330-725-8442
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-031038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine