Provider Demographics
NPI:1497070312
Name:ROBERTSON, HESS M (MD)
Entity Type:Individual
Prefix:DR
First Name:HESS
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HESS
Other - Middle Name:MCCLELLAN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1196
Mailing Address - Fax:601-984-5939
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-815-1196
Practice Address - Fax:601-984-5939
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.125205207L00000X
MS24322207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL192054Medicaid
MS09909850Medicaid
MS524065YJ5DMedicare PIN