MEDICARE: DR. STEPHEN A ROBERTS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO640	AL

General Provider Information

NPI Number	:	1063416667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN A ROBERTS D.O.

Provider Business Mailing Address
First Line	:	1771 SKYLAND BLVD E
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-4235
Country	:	US
Telephone Number	:	205-553-0199
Fax Number	:	205-553-3024

Provider Business Practice Location Address
First Line	:	1771 SKYLAND BLVD E
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-4235
Country	:	US
Telephone Number	:	205-553-0199
Fax Number	:	205-553-3024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/24/2009

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