Healthcare Provider Details

I. General information

NPI: 1265540603
Provider Name (Legal Business Name): ROBERT K PARTRIGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CENTRAL AVE E
WIGGINS MS
39577-9602
US

IV. Provider business mailing address

1440 CENTRAL AVE E
WIGGINS MS
39577-9602
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-6700
  • Fax:
Mailing address:
  • Phone: 601-928-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13459
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: