Provider Demographics
NPI:1689946519
Name:DR.DAVID ROBERSON JR.DPM LLC
Entity Type:Organization
Organization Name:DR.DAVID ROBERSON JR.DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-942-0514
Mailing Address - Street 1:840 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6506
Mailing Address - Country:US
Mailing Address - Phone:205-942-0514
Mailing Address - Fax:205-942-8523
Practice Address - Street 1:840 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6506
Practice Address - Country:US
Practice Address - Phone:205-942-0514
Practice Address - Fax:205-942-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL87213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51086600OtherBLUE CROSS
AL000086600Medicare PIN
ALT68892Medicare UPIN