Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 00012680 | AL |
N | 208D00000X | General Practice Physician | 12680 | AL |
NPI | 1003896325 |
---|---|
Provider Name | Howard Mason Robertson JR. |
First Address | Huntsville, AL 35801-4551 |
Second Address | Huntsville, AL 35801-4421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 04/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000024079 | (05) | AL |
009975805 | (05) | AL |
3074889 | BCBS TN (01) | TN |
51000010 | BCBS MADISON SURG CTR (01) | AL |
51024079 | BCBS AL (01) | AL |
C71554 | (02) | AL |