Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101246759 | VA |
Y | 208000000X | Pediatrician | 42695 | AL |
NPI | 1003013459 |
---|---|
Provider Name | Porsche L. Roberson |
First Address | Huntsville, AL 35804-2705 |
Second Address | Hazel Green, AL 35750-8618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 22/06/2021 |