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Individual

DR. ROBERT W THEAKSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
211 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3755
(256) 845-9355
Mailing address
211 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3755
(256) 845-9355
(256) 845-7824

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19991
AL
208D00000X
General Practice Physician
Primary
19991
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009932309
AL
Enumeration date
06/14/2006
Last updated
10/03/2013
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