Basic Information
| Provider Information | |||||||||
| NPI: | 1831123215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELFREY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 W MAIN ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363051054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347939564 | ||||||||
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| Practice Location | |||||||||
| Address1: | 614 N MAIN ST STE B | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3433488884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G35838 | CA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD.7831 | AL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | MD.7831 | 01 | AL | ALABAMA LICENSE | OTHER | 200337460A | 05 | OK | MEDICAID | 200505990K | 05 | OK | MEDICAID | 211693 | 05 | AL | MEDICAID |