Healthcare Provider Details

I. General information

NPI: 1902996713
Provider Name (Legal Business Name): PAUL ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WALKER CHAPEL PLZ SUITE 115
FULTONDALE AL
35068-3401
US

IV. Provider business mailing address

339 WALKER CHAPEL PLZ SUITE 115
FULTONDALE AL
35068-3401
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-2844
  • Fax:
Mailing address:
  • Phone: 205-841-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24557
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: