MEDICARE: MR. ROBERT LEE STEELE IV PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	PA00396	MS
2	363AM0700X	Medical Physician Assistant	PA00396	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053887208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE STEELE IV PA-C

Provider Business Mailing Address
First Line	:	404 GLENHAVEN DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2425
Country	:	US
Telephone Number	:	662-471-1805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 HIGHWAY 178 W STE A
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650-9233
Country	:	US
Telephone Number	:	662-988-7041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	07/18/2022

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