DR. BRUCE E ROBERTS (NPI# 1770570038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770570038 |
| Entity Type | Individual |
| Full Name | DR. BRUCE E ROBERTS |
| Credential | M.D. |
| Practice Address |
5345 Highway 18 W Jackson MS 39209-9421 |
| Practice Telephone | 6019245007 |
| Practice Fax Number | 6019239921 |
| Mailing Telephone | 6019245007 |
| Mailing Fax Number | 6019239921 |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2008-01-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 09179 | MS | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 09179 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | DR | C48217 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912974684 | Bruce Roberts | Psychiatry & Neurology | 275 Poplar Rd, Highland Park, IL 60035-4346 | 2006-03-02 |
| 1760851588 | Bruce Roberts | Counselor | 2507 Christie Drive, Christie Campus, Lake Oswego, OR 97034 | 2015-09-22 |
| 1740695311 | Bruce A Roberts | Pharmacist | 4609 Kirkwood Hwy, Wilmington, DE 19808-5005 | 2014-06-23 |
| 1891872982 | Bruce T Roberts | Internal Medicine | 463 Bmh Physicians Office Bldg, Maryville, TN 37804-5807 | 2006-11-01 |
| 1639193683 | Bruce E. Roberts | Psychologist | 859 Willard St, Ste 430, Quincy, MA 02169-7482 | 2006-07-26 |
| 1912940305 | Bruce Allen Roberts | Family Medicine | 2443 Fillmore St # 380-3991, San Francisco, CA 94115-1814 | 2006-06-13 |
| 1104828821 | Bruce John Roberts | Obstetrics & Gynecology | 7777 Forest Ln, C-234, Dallas, TX 75230-2505 | 2005-08-12 |
| Street Address |
5345 HIGHWAY 18 W |
| City | JACKSON |
| State | MS |
| Zip Code | 39209-9421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881862449 | River Oaks Management Company, LLC | Family Medicine | 5345 Highway 18 W, Jackson, MS 39209-9421 | 2008-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1760003594 | Phi Health, LLC | Ambulance | 582 Ramp Road, Suite C, Jackson, MS 39209 | 2020-05-04 |
| 1720468911 | Genoa Healthcare, LLC | Pharmacy | 3450 Highway 80 W Rm 68, Jackson, MS 39209 | 2015-06-03 |
| 1013302082 | Tiffany Griffin | Nurse Practitioner | 3450 Highway 80 West, Jackson, MS 39209 | 2015-04-06 |
| 1679961957 | Cassetta Shontae Mcgee | Emergency Medical Technician, Basic | 5326 Queen Eleanor Ln, Jackson, MS 39209 | 2015-01-08 |
| 1124381280 | Martin Solution | In Home Supportive Care | 917 West Ridge, Jackson, MS 39209 | 2012-06-22 |
| 1649533589 | Adrinnie M Martin | Contractor | 917 Westridge, Jackson, MS 39209 | 2012-06-15 |
| 1831423862 | Infinity House, Inc | In Home Supportive Care | 1042 Pecan Park Circle, Jackson, MS 39209 | 2009-09-23 |
| 1174751093 | Linda M Vance | Nurse Practitioner | 1000 Metrocenter Ste 105, Jackson, MS 39209 | 2009-06-30 |
| 1770729998 | Kim Hestle | Speech-Language Pathologist | 733 N. Flag Chapel Road, Jackson, MS 39209 | 2008-12-17 |
| Find all providers in zip 39209 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366991523 | Jackson State University | General Practice | 1400 Jr Lynch St, Jackson, MS 39217-0002 | 2016-09-29 |
| 1124475371 | Donald Lafont | General Practice | 331 Edenwood Dr, Jackson, TN 38301-3432 | 2016-05-18 |
| 1669717302 | Lift Wellness Inc | General Practice | 101 Jackson Walk Plaza, Jackson, TN 38301 | 2012-12-06 |
| 1457665333 | Teton County Hospital District | General Practice | Box 428 625 E Broadway Ave, Jackson, WY 83001-8642 | 2010-08-03 |
| 1851524730 | Byrd Lamar Payne | General Practice | 1205 Lyncrest Ave, Jackson, MS 39202-2106 | 2009-08-26 |
| 1801031703 | Total Spine Surgical Center LLC | General Practice | 1455 College Ave, Jackson, AL 36545-2410 | 2008-12-05 |
| 1992974018 | Visiting Doctors PC | General Practice | 2108 4th St Ste A, Jackson, MI 49203-4518 | 2008-02-22 |
| 1821127093 | Peter Thomas Gardner | General Practice | 2075 Pleasant Plains Ext Rd, Jackson, TN 38305-6087 | 2007-03-05 |
| 1154491579 | Bruce Hayse | General Practice | 269 West Broadway, Jackson, WY 83001-1884 | 2006-11-09 |
| 1104880558 | Lorna Gaye Pinson | General Practice | 3235 East Michigan Ave, Jackson, MI 49202 | 2006-04-13 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.