Healthcare Provider Details

I. General information

NPI: 1891734455
Provider Name (Legal Business Name): ROBERT DETRINIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 ROPER LN
DAPHNE AL
36526-5274
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-2211
  • Fax:
Mailing address:
  • Phone: 251-450-5916
  • Fax: 251-662-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLA9582R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.44998
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: