Provider Demographics
NPI:1114930468
Name:HEATH, ROBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SUMMER PL
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8222
Mailing Address - Country:US
Mailing Address - Phone:601-520-2501
Mailing Address - Fax:
Practice Address - Street 1:90 SUMMER PL
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8222
Practice Address - Country:US
Practice Address - Phone:601-520-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113720Medicaid
MS64050757285OtherAMERICAN ADMIN GROUP
LA1790231Medicaid
LA1790231Medicaid
080052881OtherRAILROAD MEDICARE
MS64050757285OtherAMERICAN ADMIN GROUP