Provider Demographics
NPI:1487662763
Name:DECOUX, ROBERT E JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DECOUX
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:PO BOX 511
Mailing Address - Street 2:102 WEST FREEDOM DRIVE
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-0511
Mailing Address - Country:US
Mailing Address - Phone:601-657-4326
Mailing Address - Fax:601-657-8867
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:SUITE 1300
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-249-3541
Practice Address - Fax:601-249-3544
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS07001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1558935OtherAMERICAN ADMIN GROUP
100002670OtherRAILROAD MEDICARE
MS00012512Medicaid
MS468216YWSVMedicare Oscar/Certification
MS00012512Medicaid
100002670OtherRAILROAD MEDICARE