Provider Demographics
NPI:1841204443
Name:ISRAEL, ROBERT WILLIS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIS
Last Name:ISRAEL
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 1:6701 AIRPORT BLVD.
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-633-8880
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:6304 USA HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-0020
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:251-634-4506
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000093046Medicaid
000093046Medicare ID - Type Unspecified
C73511Medicare UPIN