Provider Demographics
NPI:1447370069
Name:ROBERTS, MICHAEL D (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:STE D430B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-631-3270
Mailing Address - Fax:251-631-3273
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:STE D430B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-631-3270
Practice Address - Fax:251-631-3273
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-110568367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01100504Medicaid
AL051558845Medicaid
AL051558845Medicare PIN