Healthcare Provider Details

I. General information

NPI: 1720289424
Provider Name (Legal Business Name): ROBERT TODD SEABROOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR STE 45
JACKSON MS
39216-4640
US

IV. Provider business mailing address

PO BOX 649113
DALLAS TX
75264-9113
US

V. Phone/Fax

Practice location:
  • Phone: 601-313-9802
  • Fax: 601-313-9804
Mailing address:
  • Phone: 855-343-5763
  • Fax: 855-343-5763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD44865
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-17125
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33417
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: