Provider Demographics
NPI:1407817240
Name:RIGSBY, REGINALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:D
Last Name:RIGSBY
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0607
Mailing Address - Country:US
Mailing Address - Phone:601-859-9888
Mailing Address - Fax:601-859-9004
Practice Address - Street 1:1082 GLUCKSTADT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7243
Practice Address - Country:US
Practice Address - Phone:601-707-5621
Practice Address - Fax:601-707-5627
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118310Medicaid
MSB30368Medicare UPIN
MS00118310Medicaid