Provider Demographics
NPI:1730283201
Name:ROBBINS, JERRY EDWARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:EDWARD
Last Name:ROBBINS
Suffix:II
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 1:885 N CEDAR COVE RD
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-4957
Mailing Address - Country:US
Mailing Address - Phone:256-751-2160
Mailing Address - Fax:
Practice Address - Street 1:2941 POINT MALLARD PKWY SE STE N
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5760
Practice Address - Country:US
Practice Address - Phone:256-432-2822
Practice Address - Fax:256-432-2825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21372207Q00000X
AL00021372207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL089916305Medicaid
AL089916305Medicaid
AL051554751Medicare ID - Type Unspecified