Provider Demographics
NPI:1881615995
Name:MCALPIN, BRODIE WAYNE JR (MD)
Entity type:Individual
Prefix:
First Name:BRODIE
Middle Name:WAYNE
Last Name:MCALPIN
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 1:209 N HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5271
Mailing Address - Country:US
Mailing Address - Phone:662-286-1901
Mailing Address - Fax:662-286-3132
Practice Address - Street 1:209 N HARPER RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5271
Practice Address - Country:US
Practice Address - Phone:662-286-1901
Practice Address - Fax:662-286-3132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13899207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119631Medicaid
MS290000061Medicare ID - Type Unspecified
MS00119631Medicaid