Provider Demographics
NPI:1447291208
Name:ROBERSON, ELIZABETH ANN S (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH ANN
Middle Name:S
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 LANTANA LN
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4777
Mailing Address - Country:US
Mailing Address - Phone:850-585-3365
Mailing Address - Fax:850-837-5999
Practice Address - Street 1:239 METHODIST BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1297
Practice Address - Country:US
Practice Address - Phone:601-268-5026
Practice Address - Fax:601-268-8645
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME885252084P0800X
NC2008-003942084P0800X, 2084P0805X
TXK30012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37635YMedicare ID - Type UnspecifiedPROVIDER MEDICARE
FLH31929Medicare UPIN