Healthcare Provider Details

I. General information

NPI: 1972181196
Provider Name (Legal Business Name): ROBERT HOLLIS BURROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 TREETOPS BLVD STE 101
FLOWOOD MS
39232-7645
US

IV. Provider business mailing address

2438 CULLEYWOOD RD
JACKSON MS
39211-4916
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35333
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35333
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: