Provider Demographics
NPI:1649254459
Name:ALALY, ROBERT M (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:ALALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3153 DEPT 30755
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9283
Mailing Address - Country:US
Mailing Address - Phone:314-238-5260
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:1201 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5403
Practice Address - Country:US
Practice Address - Phone:731-885-2410
Practice Address - Fax:314-821-1833
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR76292085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
140376000OtherDEPT OF LABOR
MO201196136Medicaid
4964V4964OtherGHP
P00133934OtherTRAVELERS
431142188OSUOtherMERCY
MO112315OtherHEALTHLINK
1600251OtherUHC
MO1765OtherBCBS
431142188OSUOtherMERCY
4964V4964OtherGHP
MO002010520Medicare PIN