Provider Demographics
NPI:1700826443
Name:SWAIN, ROBERTA G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:G
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4300 OLD SHELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2036
Mailing Address - Country:US
Mailing Address - Phone:251-342-7880
Mailing Address - Fax:251-342-8369
Practice Address - Street 1:4300 OLD SHELL RD STE B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2036
Practice Address - Country:US
Practice Address - Phone:251-342-7880
Practice Address - Fax:251-342-8369
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL23693207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I070018OtherMEDICARE
AL510I070018OtherRAILROAD MEDICARE
AL51594108OtherBLUE CROSS BLUE SHIELD OF ALABAMA