Individual
DR. ROBERT T BRODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 815-3374
Mailing address
2500 NORTH STATE STREET, UMMC-DEPARTMENT OF DERMATOLOGY, JACKSON, MS 39216-4500
(601) 815-3374
(601) 815-6613
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
22119
MS
207N00000X
Dermatology Physician
35051453
OH
207ND0900X
Dermatopathology Physician
35051453
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08970301
—
MS
01
—
P01087832
RAILROAD MEDICARE
MS
Enumeration date
07/28/2005
Last updated
10/06/2017
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