Provider Demographics
NPI:1720289424
Name:SEABROOK, ROBERT TODD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:SEABROOK
Suffix:
Gender:M
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:PO BOX 649113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-9113
Mailing Address - Country:US
Mailing Address - Phone:855-343-5763
Mailing Address - Fax:855-343-5763
Practice Address - Street 1:970 LAKELAND DR STE 45
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4640
Practice Address - Country:US
Practice Address - Phone:601-313-9802
Practice Address - Fax:601-313-9804
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD44865207L00000X
ARE-17125207L00000X
MS33417207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0024398OtherINSTITUTIONAL PERMIT
TN3041578Medicare PIN