Provider Demographics
NPI:1982790572
Name:SCIACCA, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:SCIACCA
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 1:4515 SOUTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-985-7393
Mailing Address - Fax:205-987-1332
Practice Address - Street 1:4515 SOUTHLAKE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-985-7393
Practice Address - Fax:205-987-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08954207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000082846Medicaid
AL51534513OtherBCBS
AL630967865OtherTAX ID
AL040004918OtherMCRRR
AL167432400OtherOWCP
AL51082846OtherBCBS
AL167432400OtherOWCP
AL630967865OtherTAX ID