Provider Demographics
NPI:1790734960
Name:MIDDLETON, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MIDDLETON
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 1:971 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 1052
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-2706
Mailing Address - Country:US
Mailing Address - Phone:601-914-9503
Mailing Address - Fax:601-981-7895
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 1052
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-914-9503
Practice Address - Fax:601-981-7895
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13782207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120557Medicaid
MSC73762Medicare UPIN
MS00120557Medicaid