=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528089794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ERIC FOROPOULOS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 06/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 ALCORN DR SUITE 100
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6369
-----------------------------------------------------
Fax | 662-286-2768
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 ALCORN DR SUITE 100
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-9321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6369
-----------------------------------------------------
Fax | 662-286-2768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 12912
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------