Provider Demographics
NPI:1669460937
Name:MCGUIRE, ROBERT A JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MCGUIRE
Suffix:JR
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 1:2500 N STATE STREET
Mailing Address - Street 2:PO BOX 3188
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39207-3188
Mailing Address - Country:US
Mailing Address - Phone:601-984-6525
Mailing Address - Fax:601-984-5151
Practice Address - Street 1:2500 N STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-6525
Practice Address - Fax:601-984-5151
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12422207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL155644Medicaid
MS512I200012OtherPTAN
MS200014931OtherRAILROAD MEDICARE
MSP00462275OtherRAILROAD MEDICARE PTAN
MS00016005Medicaid
MSP00462275OtherRAILROAD MEDICARE PTAN
AL155644Medicaid
MNE69079Medicare UPIN
MS0446640001Medicare NSC
MSP01118781Medicare PIN