Active NPI
Earl Robertson, CP, LPO
- Prosthetist
- Memphis, TN
National Provider Identifier
1629502968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- LP 49
- Practice address
- 722 N White Station Rd
Memphis, TN 38122-4422 - Phone
- (901) 763-6999
- Fax
- (901) 682-9062
- NPI assigned
- Apr 13, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | LO 58 | TN | |
| Prosthetist | 224P00000X | LP 49 | TN | Primary |
Addresses
Primary practice location
722 N White Station Rd
Memphis, TN 38122-4422
Mailing address
722 N White Station Rd
Memphis, TN 38122-4422
Phone (901) 763-6999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP 1357 | Other | ABC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LO 58 | TN | MD | Orthotist |
| LP 49 | TN | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492041600000",
"number": "1629502968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "722 N WHITE STATION RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381224422",
"telephone_number": "901-763-6999",
"fax_number": "901-682-9062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "722 N WHITE STATION RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381224422",
"telephone_number": "901-763-6999",
"fax_number": "901-682-9062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "EARL",
"name_prefix": "Mr.",
"credential": "CP, LPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-13",
"last_updated": "2017-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "TN",
"license": "LO 58",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "TN",
"license": "LP 49",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ABC",
"identifier": "CP 1357",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.