Healthcare Provider Details

I. General information

NPI: 1992719181
Provider Name (Legal Business Name): ROBERT GRAHAM SEXTON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR DEPT. OF RADIOLOGY
CORINTH MS
38834-9368
US

IV. Provider business mailing address

PO BOX 9186
LONGVIEW TX
75608-9186
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1466
  • Fax:
Mailing address:
  • Phone: 903-663-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-4205
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17901
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD0000039143
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1017917
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: