Provider Demographics
NPI:1720054224
Name:GOOLSBY, ROBERT PATTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PATTEN
Last Name:GOOLSBY
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 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-933-4020
Mailing Address - Fax:205-933-4022
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 306
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-4020
Practice Address - Fax:205-933-4022
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17106207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009914745Medicaid
AL51512637Medicare ID - Type Unspecified
ALG02747Medicare UPIN