Individual
ROBERT KEITH DUBARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
(662) 227-7572
Mailing address
234 COURTSIDE DR S, GRENADA, MS 38901-5536
(662) 226-0287
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R538302
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00017441
—
MS
01
—
R538302
ST
MS
Enumeration date
10/09/2007
Last updated
01/23/2017
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