Provider Demographics
NPI:1982921748
Name:ROBERTS, ERIC EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N MCKENZIE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2282
Mailing Address - Country:US
Mailing Address - Phone:251-949-3479
Mailing Address - Fax:251-949-3434
Practice Address - Street 1:1711 N MCKENZIE ST STE 201
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2282
Practice Address - Country:US
Practice Address - Phone:251-952-6597
Practice Address - Fax:251-952-6620
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1763208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02922368Medicaid
AL233737Medicaid
AL234153Medicaid