Provider Demographics
NPI:1780741322
Name:ROBERSON, DAVID II (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ROBERSON
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6506
Mailing Address - Country:US
Mailing Address - Phone:205-942-0514
Mailing Address - Fax:205-942-8523
Practice Address - Street 1:840 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6506
Practice Address - Country:US
Practice Address - Phone:205-942-0514
Practice Address - Fax:205-942-8523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL87213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51086600OtherBLUE CROSS
AL51086600OtherBLUE CROSS
AL000086600Medicare ID - Type Unspecified