Organization
MID SOUTH OTOLARYNGOLOGY ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MOORE FISHER MD (OWNER)
(662) 349-4250
Entity
Organization
Contact information
Practice address
6890 ELMORE RD, SUITE 2, SOUTHAVEN, MS 38671-9673
(662) 349-4250
(662) 349-4249
Mailing address
PO BOX 1167, 6890 ELMORE RD STE 2, SOUTHAVEN, MS 38671
(662) 349-4250
(662) 349-4249
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
04813
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018019
—
MS
01
—
DB8666
RAILROAD MEDICARE
MS
Enumeration date
12/06/2006
Last updated
10/22/2010
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