Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 08437 | AL |
NPI | 1548289218 |
---|---|
Provider Name | Steven Pearce Roberts |
First Address | Birmingham, AL 35235-3134 |
Second Address | Birmingham, AL 35235-3134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C75482 | (02) | AL |
H773 | MEDICARE GROUP # (01) | AL |