Provider Demographics
NPI:1639259518
Name:STRONG, ROBERT CLIFTON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLIFTON
Last Name:STRONG
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 1:1115 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5102
Mailing Address - Country:US
Mailing Address - Phone:601-634-8790
Mailing Address - Fax:601-883-5000
Practice Address - Street 1:1115 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5102
Practice Address - Country:US
Practice Address - Phone:601-634-8790
Practice Address - Fax:601-883-5000
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07719207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019273Medicaid
MS4228401OtherAETNA
MS00019273Medicaid
MSP00362306Medicare PIN
MSC47963Medicare UPIN
MS00019273Medicaid