Southworth, Stephen Robert

Southworth, Stephen Robert is an individual health care provider with primary practice located at 499 Gloster Creek Vlg Ste G1 , Tupelo MS 38801-4751. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Foot and Ankle Surgery, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Southworth, Stephen Robert can be contacted via phone (662) 377-2663.

Contact Information

Primary practice address
499 Gloster Creek Vlg Ste G1 Tupelo MS 38801-4751
Phone: (662) 377-2663
Fax: (662) 377-6706
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery 207XS0114X 16972 Mississippi
Allopathic & Osteopathic Physicians / Foot and Ankle Surgery 207XX0004X 16972 Mississippi
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 16972 Mississippi

Profile Details

NPI number 1437120730
LBN Legal business name Southworth, Stephen Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Jan 26th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437120730 NPPES
Mississippi MEDICAID 00123102

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