Provider Demographics
NPI:1760169486
Name:TINKER, ROOSEVELT III
Entity Type:Individual
Prefix:MR
First Name:ROOSEVELT
Middle Name:
Last Name:TINKER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BOULEVARD SOUTH SW STE 104A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2175
Mailing Address - Country:US
Mailing Address - Phone:334-267-5276
Mailing Address - Fax:
Practice Address - Street 1:4758 WOODMERE BLVD STE F
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3076
Practice Address - Country:US
Practice Address - Phone:334-267-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle