Provider Demographics
NPI:1003896325
Name:ROBERTSON, HOWARD MASON JR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:MASON
Last Name:ROBERTSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOWARD
Other - Middle Name:MASON
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4551
Mailing Address - Country:US
Mailing Address - Phone:256-539-9471
Mailing Address - Fax:256-539-9472
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012680207L00000X
AL12680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024079Medicaid
AL009975805Medicaid
AL51000010OtherBCBS MADISON SURG CTR
TN3074889OtherBCBS TN
AL51024079OtherBCBS AL
AL51000010OtherBCBS MADISON SURG CTR
AL000024079Medicare ID - Type UnspecifiedHH LOCATIONS
AL009975805Medicaid