Individual
ALEXEY FOMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
104 MILLSAPS DR, HATTIESBURG, MS 39402-1328
(601) 288-7500
(601) 268-5179
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 288-7500
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24153
MS
207R00000X
Internal Medicine Physician
47117
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04537068
—
MS
Enumeration date
09/04/2013
Last updated
07/09/2020
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