Healthcare Provider Details

I. General information

NPI: 1982710760
Provider Name (Legal Business Name): ROBERT L ROE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24980 STATE ST PO DRAWER 519
ELBERTA AL
36530-2573
US

IV. Provider business mailing address

24980 STATE ST PO DRAWER 519
ELBERTA AL
36530-2573
US

V. Phone/Fax

Practice location:
  • Phone: 251-986-7301
  • Fax: 251-986-5927
Mailing address:
  • Phone: 251-986-7301
  • Fax: 251-986-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27758
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: