Provider Demographics
NPI:1790750065
Name:ROBERSON, LEE DOUGLASS (MD)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:DOUGLASS
Last Name:ROBERSON
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 1:833 PRINCETON AVE. SW
Mailing Address - Street 2:200A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211
Mailing Address - Country:US
Mailing Address - Phone:205-786-2776
Mailing Address - Fax:205-786-6227
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:#200A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-786-2776
Practice Address - Fax:205-786-6227
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51905208G00000X
AL00019855208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960240Medicaid
AL02404Medicare ID - Type Unspecified
AL009960240Medicaid