Provider Demographics
NPI:1164659389
Name:ROBERTS, JARED MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT VINCENTS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1629
Mailing Address - Country:US
Mailing Address - Phone:205-933-8334
Mailing Address - Fax:205-933-8466
Practice Address - Street 1:800 SAINT VINCENTS DR STE 500
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-933-8334
Practice Address - Fax:205-933-8466
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30765207V00000X
390200000X
AL30765207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program