Provider Demographics
NPI:1528083763
Name:ROBBINS, THEODORE DALE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:DALE
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:IAN
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:ALICEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35442-0354
Mailing Address - Country:US
Mailing Address - Phone:205-373-3945
Mailing Address - Fax:205-373-2653
Practice Address - Street 1:108 5TH ST NE
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-2200
Practice Address - Country:US
Practice Address - Phone:205-373-3945
Practice Address - Fax:205-373-2653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051084557OtherBLUE CROSS BLUE SHIELD OF
AL1830OtherTHE OATH
AL110023031OtherPALMETTO GBA RAILROAD MCR
AL000084557Medicaid
AL4253828OtherAETNA
AL63-1075891OtherTAX ID