Healthcare Provider Details

I. General information

NPI: 1154580249
Provider Name (Legal Business Name): DEEPU RAPHAEL THOPPIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

IV. Provider business mailing address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

V. Phone/Fax

Practice location:
  • Phone: 601-399-6169
  • Fax: 601-399-6168
Mailing address:
  • Phone: 601-399-6169
  • Fax: 601-399-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24167
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: