Healthcare Provider Details

I. General information

NPI: 1306057807
Provider Name (Legal Business Name): DWIGHT TIMOTHY FLOWERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

274 BAYVIEW DR
MADISON MS
39110-9176
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4001
  • Fax: 601-984-5583
Mailing address:
  • Phone: 601-853-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT1794
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: