Provider Demographics
NPI:1366455545
Name:HERRINGTON, ROBERT R III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:HERRINGTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-736-8282
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:502 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3037
Practice Address - Country:US
Practice Address - Phone:601-736-8282
Practice Address - Fax:601-736-8533
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080021125OtherRAILROAD MEDICARE
MS1432915OtherUNITED HEALTHCARE
LA1419737Medicaid
MS00015363Medicaid
MS64050757237OtherAMERICAN ADMIN GROUP
B65001Medicare UPIN
MS080000539Medicare PIN