Individual
DR. JOHN BOONE ROBERSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
811 SOUTH 28TH AVENUE, HATTIESBURG, MS 39402
(601) 261-2611
(601) 261-2711
Mailing address
811 SOUTH 28TH AVENUE, HATTIESBURG, MS 39402
(601) 261-2611
(601) 261-2711
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
274693
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660451
—
MS
05
—
01951327
—
MS
Enumeration date
08/18/2006
Last updated
03/07/2012
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