Healthcare Provider Details

I. General information

NPI: 1205817509
Provider Name (Legal Business Name): DAVID H ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 NORTH ST E
TALLADEGA AL
35160-2529
US

IV. Provider business mailing address

803 NORTH ST E
TALLADEGA AL
35160-2529
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-1600
  • Fax: 256-362-8698
Mailing address:
  • Phone: 256-362-1600
  • Fax: 256-362-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10740
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: