Healthcare Provider Details

I. General information

NPI: 1972124964
Provider Name (Legal Business Name): DANNY GABRIEL ROBLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 1460
JACKSON MS
39216-4621
US

IV. Provider business mailing address

971 LAKELAND DR STE 1460
JACKSON MS
39216-4621
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-3202
  • Fax: 601-982-3658
Mailing address:
  • Phone: 601-982-3202
  • Fax: 601-982-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37670
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: