Healthcare Provider Details

I. General information

NPI: 1558361519
Provider Name (Legal Business Name): HENRY PATELFORD EWING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST NMMC EAST TOWER 4TH FLOOR
TUPELO MS
38801-4934
US

IV. Provider business mailing address

PO BOX 7062
TUPELO MS
38802-7062
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-7170
  • Fax: 662-377-2423
Mailing address:
  • Phone: 662-377-7170
  • Fax: 662-377-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number07411
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: