Provider Demographics
NPI:1265688865
Name:ROBERSON, ANN C (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:C
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1151 N. STATE ST.
Mailing Address - Street 2:SUITE 311
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-969-1171
Mailing Address - Fax:601-969-1173
Practice Address - Street 1:1151 N. STATE ST.
Practice Address - Street 2:SUITE 311
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:601-969-1171
Practice Address - Fax:601-969-1173
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST2132207L00000X
MS22093207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology