Healthcare Provider Details

I. General information

NPI: 1588763197
Provider Name (Legal Business Name): JAMES ROBERT HOUSE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 E LAYFAIR DR
FLOWOOD MS
39232-9526
US

IV. Provider business mailing address

290 E LAYFAIR DR
FLOWOOD MS
39232-9526
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-2825
  • Fax: 601-981-2827
Mailing address:
  • Phone: 601-981-2825
  • Fax: 601-981-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11369
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: