Healthcare Provider Details

I. General information

NPI: 1548202385
Provider Name (Legal Business Name): VERNON W. BARROW III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CROSSOVER ROAD
TUPELO MS
38801-4944
US

IV. Provider business mailing address

620 CROSSOVER RD
TUPELO MS
38801-4944
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-7102
  • Fax: 662-620-7106
Mailing address:
  • Phone: 662-620-7102
  • Fax: 662-842-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12472
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: