Healthcare Provider Details

I. General information

NPI: 1700826443
Provider Name (Legal Business Name): ROBERTA G SWAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 OLD SHELL RD STE B
MOBILE AL
36608-2036
US

IV. Provider business mailing address

4300 OLD SHELL RD STE B
MOBILE AL
36608-2036
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-7880
  • Fax: 251-342-8369
Mailing address:
  • Phone: 251-342-7880
  • Fax: 251-342-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number23693
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: