Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | DO 287 | AL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 287 | AL |
NPI | 1699889873 |
---|---|
Provider Name | Jerry Russell Robinson |
First Address | Huntsville, AL 35804-2705 |
Second Address | Boaz, AL 35957-1763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009968600 | (05) | AL |
51504831 | BLUE CROSS BLUE SHIELD (01) | AL |
631283020 | TAX ID (01) | AL |