Basic Information
| Provider Information | |||||||||
| NPI: | 1003013459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERSON | ||||||||
| FirstName: | PORSCHE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564284950 | ||||||||
| FaxNumber: | 2568280526 | ||||||||
| Practice Location | |||||||||
| Address1: | 13596 HIGHWAY 231 431 N STE 2 | ||||||||
| Address2: | |||||||||
| City: | HAZEL GREEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357508618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564284950 | ||||||||
| FaxNumber: | 2568280526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101246759 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 42695 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.