Healthcare Provider Details

I. General information

NPI: 1730295064
Provider Name (Legal Business Name): MICHAEL LYNN PEERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR SUITE 110
CORINTH MS
38834-9321
US

IV. Provider business mailing address

PO BOX 2040
CORINTH MS
38835-2040
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1565
  • Fax: 662-293-4204
Mailing address:
  • Phone: 662-287-6913
  • Fax: 662-287-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number16678
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number16678
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number16678
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: