Individual
ROBERT JOSEPH DERVELOY III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 S GLOSTER ST, NMMC EAST TOWER 4TH FLOOR, TUPELO, MS 38801-4934
(662) 377-7170
(662) 377-2423
Mailing address
PO BOX 7062, TUPELO, MS 38802-7062
(662) 377-7170
(662) 377-2423
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
12390
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118384
—
MS
01
—
730-10331
BCBS
AL
Enumeration date
07/29/2005
Last updated
07/08/2007
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