Healthcare Provider Details

I. General information

NPI: 1275162125
Provider Name (Legal Business Name): ANDRES NARVAEZ CORDOVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

IV. Provider business mailing address

107 CATHERINE BLVD
CLINTON MS
39056-6607
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-5000
  • Fax:
Mailing address:
  • Phone: 601-883-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37249
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: