Provider Demographics
NPI:1235117607
Name:ROBERTSON, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PROVIDENCE PARK
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4680
Mailing Address - Country:US
Mailing Address - Phone:205-982-7220
Mailing Address - Fax:205-982-7228
Practice Address - Street 1:2001 PROVIDENCE PARK
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4680
Practice Address - Country:US
Practice Address - Phone:205-982-7220
Practice Address - Fax:205-982-7228
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18109207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL240004512OtherMEDICARE RAILROAD
AL631164786OtherTAX ID
AL631164786OtherTAX ID
AL240004512OtherMEDICARE RAILROAD