Individual
DR. BRUCE E ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5345 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 924-5007
(601) 923-9921
Mailing address
5345 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 924-5007
(601) 923-9921
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
09179
MS
208D00000X
General Practice Physician
Primary
09179
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C48217
DR
MS
Enumeration date
10/03/2005
Last updated
01/28/2008
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