Provider Demographics
NPI:1619398294
Name:EUBANKS, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:EUBANKS
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:AL
Mailing Address - Zip Code:36559-0655
Mailing Address - Country:US
Mailing Address - Phone:251-928-2029
Mailing Address - Fax:
Practice Address - Street 1:3 OAK LN
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:AL
Practice Address - Zip Code:36559-0655
Practice Address - Country:US
Practice Address - Phone:251-928-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist