Provider Demographics
NPI:1780643494
Name:HUEY, ROGER L (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:HUEY
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 21
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0021
Mailing Address - Country:US
Mailing Address - Phone:662-680-5565
Mailing Address - Fax:662-680-5654
Practice Address - Street 1:589 GARFIELD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6301
Practice Address - Country:US
Practice Address - Phone:662-680-5565
Practice Address - Fax:662-680-5654
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13186207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111231Medicaid
MS00111231Medicaid
MS1000000188Medicare ID - Type Unspecified