Healthcare Provider Details

I. General information

NPI: 1841250156
Provider Name (Legal Business Name): JOHN DOUGLAS ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6727 TAYLOR COURT
MONTGOMERY AL
36117-7708
US

IV. Provider business mailing address

6727 TAYLOR COURT
MONTGOMERY AL
36117-7708
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-2800
  • Fax: 334-284-0438
Mailing address:
  • Phone: 334-284-2800
  • Fax: 334-284-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24023
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number24023
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: