Healthcare Provider Details

I. General information

NPI: 1528083763
Provider Name (Legal Business Name): THEODORE DALE ROBBINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THEODORE IAN ROBBINS M.D.

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 5TH ST NE
ALICEVILLE AL
35442-2200
US

IV. Provider business mailing address

PO BOX 354
ALICEVILLE AL
35442-0354
US

V. Phone/Fax

Practice location:
  • Phone: 205-373-3945
  • Fax: 205-373-2653
Mailing address:
  • Phone: 205-373-3945
  • Fax: 205-373-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00013025
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: