Provider Demographics
NPI:1871590570
Name:ROBERSON, MATTHEW BRUCE (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRUCE
Last Name:ROBERSON
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 1:1151 S NEVADA HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4700
Mailing Address - Country:US
Mailing Address - Phone:775-727-8900
Mailing Address - Fax:757-279-4527
Practice Address - Street 1:1151 S NEVADA HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4700
Practice Address - Country:US
Practice Address - Phone:775-727-8900
Practice Address - Fax:775-727-9452
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4677207Q00000X
NV18436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185333501Medicaid
TX185333502Medicaid
TX185333501Medicaid
TX8J5625Medicare PIN
TX8L2166Medicare PIN