MEDICARE: DR. MARK A ROBERTS MD

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	15010	AL
2	208VP0000X	Pain Medicine Physician	PM.282	AL
3	207Q00000X	Family Medicine Physician	15010	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275565442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A ROBERTS MD

Provider Business Mailing Address
First Line	:	106 EDWINA STREET
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401
Country	:	US
Telephone Number	:	251-578-4300
Fax Number	:	251-578-4307

Provider Business Practice Location Address
First Line	:	106 EDWINA STREET
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401
Country	:	US
Telephone Number	:	251-578-4300
Fax Number	:	251-578-4307

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/13/2022

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Directions to “ DR. MARK A ROBERTS MD” Practice Location

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