Provider Demographics
NPI:1073578886
Name:PROSSER, HARMON SIDNEY (MD)
Entity Type:Individual
Prefix:MR
First Name:HARMON
Middle Name:SIDNEY
Last Name:PROSSER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8613 MS HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-8917
Mailing Address - Country:US
Mailing Address - Phone:662-285-9460
Mailing Address - Fax:662-263-5785
Practice Address - Street 1:64 N LOUISVILLE ST
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-9217
Practice Address - Country:US
Practice Address - Phone:662-285-9050
Practice Address - Fax:662-285-9056
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS09177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115007Medicaid
D80525Medicare UPIN