1770718298 NPI number — MR. PAUL ROBERTSON MS, RDN, LDN

Table of content: MR. PAUL ROBERTSON MS, RDN, LDN (NPI 1770718298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770718298 NPI number — MR. PAUL ROBERTSON MS, RDN, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LDN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770718298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 WEST WOODROW WILSON AVENUE
Provider Second Line Business Mailing Address:
AMBULATORY SERVICES - OUTPATIENT DIETITIAN
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-2500
Provider Business Mailing Address Fax Number:
601-984-4074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 WEST WOODROW WILSON AVENUE
Provider Second Line Business Practice Location Address:
AMBULATORY SERVICES - OUTPATIENT DIETITIAN
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-815-2500
Provider Business Practice Location Address Fax Number:
601-984-4074
Provider Enumeration Date:
05/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  D1361 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com