Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 28724 | AL |
N | 207VG0400X | Gynecologist | LL27025 | SC |
N | 207VX0000X | Obstetrician | LL27025 | SC |
NPI | 1205925096 |
---|---|
Provider Name | Dr. Robert Michael Marino |
First Address | Opelika, AL 36801-5409 |
Second Address | Opelika, AL 36801-5449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100872 | (05) | AL |
510-10786 | BCBS (01) | AL |