Provider Demographics
NPI:1477561728
Name:DANFORD, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:DANFORD
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 1:415 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:601-477-2014
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:822 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2425
Practice Address - Country:US
Practice Address - Phone:601-477-2014
Practice Address - Fax:601-477-9942
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559334OtherAMERICAN ADMIN GROUP
MS00122374Medicaid
LA1682322Medicaid
MS00122374Medicaid
MS080003334Medicare PIN
MS1559334OtherAMERICAN ADMIN GROUP