Provider Demographics
NPI:1063416667
Name:ROBERTS, STEPHEN A (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1771 SKYLAND BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4235
Mailing Address - Country:US
Mailing Address - Phone:205-553-0199
Mailing Address - Fax:205-553-3024
Practice Address - Street 1:1771 SKYLAND BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4235
Practice Address - Country:US
Practice Address - Phone:205-553-0199
Practice Address - Fax:205-553-3024
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH12509Medicare UPIN
AL0896590001Medicare NSC
AL051524326ROBMedicare ID - Type Unspecified