Healthcare Provider Details

I. General information

NPI: 1659466100
Provider Name (Legal Business Name): JARROD STEWART ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MOORES MILL RD SUITE 230
AUBURN AL
36830-8480
US

IV. Provider business mailing address

2415 MOORES MILL RD SUITE 230
AUBURN AL
36830-8480
US

V. Phone/Fax

Practice location:
  • Phone: 334-502-1117
  • Fax: 334-466-2101
Mailing address:
  • Phone: 334-502-1117
  • Fax: 334-466-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL-2713
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL.2713
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29094
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: