Provider Demographics
NPI:1962486977
Name:ROBERTS, WILLIAM ALLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLYN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2935 THOUSAND OAKS DR STE 294
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3563
Mailing Address - Country:US
Mailing Address - Phone:210-494-1100
Mailing Address - Fax:210-494-1117
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-949-3920
Practice Address - Fax:251-949-3930
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD23703207X00000X
AL23703207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009951420Medicaid
AL528700580OtherGROUP MEDICAID
A03211Medicare UPIN