NPIMap

Organization Active NPI

Glenn Robertson, MD PLLC

  • Internal Medicine Physician
  • Benson, AZ
National Provider Identifier
1043684558
Registry record updated Dec 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GLENN ROBERTSON, MD PLLC
Practice address
1069 S Highway 80
Benson, AZ 85602-7008
Phone
(520) 307-3580
Fax
(877) 795-9311
NPI assigned
Nov 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Glenn G Robertson, M.D.NPI 1174533509
Title
Owner
Phone
(520) 307-3580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1069 S Highway 80
Benson, AZ 85602-7008

Mailing address

1069 S Highway 80
Benson, AZ 85602-7008
Phone (520) 307-3580

National Provider Directory

National Provider Directory

Locations

1069 S Highway 80
Benson, AZ 85602
Phone (520) 307-3580

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1043684558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 S HIGHWAY 80",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856027008",
            "telephone_number": "520-307-3580",
            "fax_number": "877-795-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 S HIGHWAY 80",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856027008",
            "telephone_number": "520-307-3580",
            "fax_number": "877-795-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN ROBERTSON, MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-307-3580",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.