MEDICARE: MR. WILLIAM RAY ROBERSON III

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	390200000X	Student in an Organized Health Care Education/Training Program		AL
2	2255A2300X	Athletic Trainer		AL

General Provider Information

NPI Number	:	1073493961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM RAY ROBERSON III

Provider Business Mailing Address
First Line	:	4400 BEACON PLACE PKWY APT 1702
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-3239
Country	:	US
Telephone Number	:	334-320-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 BEACON PLACE PKWY APT 1702
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-3239
Country	:	US
Telephone Number	:	334-320-7379
Fax Number	:

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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