Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 18109 | AL |
NPI | 1235117607 |
---|---|
Provider Name | Jeffrey Scott Robertson |
First Address | Birmingham, AL 35242-4680 |
Second Address | Birmingham, AL 35242-4680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 11/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240004512 | MEDICARE RAILROAD (01) | AL |
631164786 | TAX ID (01) | AL |
F92295 | (02) | AL |