Provider Demographics
NPI:1144209727
Name:POMPHREY, MARTIN M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:M
Last Name:POMPHREY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2163
Mailing Address - Country:US
Mailing Address - Phone:662-324-3163
Mailing Address - Fax:662-324-6334
Practice Address - Street 1:307 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2155
Practice Address - Country:US
Practice Address - Phone:662-324-3163
Practice Address - Fax:662-324-6334
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07892207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016363Medicaid
MS00016363Medicaid