Healthcare Provider Details

I. General information

NPI: 1396184149
Provider Name (Legal Business Name): ROBERT JOSEPH HARGIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AFTON WAY
CLINTON MS
39056
US

IV. Provider business mailing address

249 MATTIES WAY
DESTIN FL
32541
US

V. Phone/Fax

Practice location:
  • Phone: 850-650-4877
  • Fax:
Mailing address:
  • Phone: 850-650-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number06058
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: