Basic Information
| Provider Information | |||||||||
| NPI: | 1417186974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | BROWN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 SPRING HILL PT | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390476359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144133417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 NORTH STATE STREET | ||||||||
| Address2: | UNIVERSITY OF MISSISSIPPI MEDICAL CENTER | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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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 | 207P00000X | 753-L | MS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.