Basic Information
| Provider Information | |||||||||
| NPI: | 1447307871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | JACK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794073544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610334 | ||||||||
| FaxNumber: | 8067820097 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST | ||||||||
| Address2: | STE 260 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067928185 | ||||||||
| FaxNumber: | 8067929180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | F7107 | TX | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 000W0459 | 05 | NM | MEDICAID | 780000444 | 01 | RAIL ROAD MEDICARE | OTHER | 122634100 | 01 | FIRST CARE | OTHER | MDF7107 | 01 | WORK COMP. | OTHER | 299751 | 01 | BLACK LUNG | OTHER | Y741 | 01 | NM | NM BLUE CROSS BLUE SHIELD | OTHER | 863277 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 131796806 | 05 | TX | MEDICAID | A004 | 01 | CHAMPUS | OTHER | 131796804 | 01 | CIDC | OTHER |