Provider Demographics
NPI:1447307871
Name:ROBERTSON, DONALD JACK (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JACK
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0334
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:STE 260
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-792-8185
Practice Address - Fax:806-792-9180
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF7107208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000W0459Medicaid
780000444OtherRAIL ROAD MEDICARE
122634100OtherFIRST CARE
MDF7107OtherWORK COMP.
299751OtherBLACK LUNG
NMY741OtherNM BLUE CROSS BLUE SHIELD
863277OtherBLUE CROSS BLUE SHIELD
TX131796806Medicaid
A004OtherCHAMPUS
131796804OtherCIDC
TX131796806Medicaid
NM000W0459Medicaid