Provider Demographics
NPI:1871773671
Name:NAMIHIRA, YOSHINOBU (MD)
Entity type:Individual
Prefix:
First Name:YOSHINOBU
Middle Name:
Last Name:NAMIHIRA
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 1:3000 HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-4802
Mailing Address - Country:US
Mailing Address - Phone:601-638-9800
Mailing Address - Fax:601-638-9808
Practice Address - Street 1:3000 HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-4802
Practice Address - Country:US
Practice Address - Phone:601-638-9800
Practice Address - Fax:601-638-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10229207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017743Medicaid
LA1366501Medicaid
MS110030246OtherRR MEDICARE
MS00017743Medicaid
MS110030246OtherRR MEDICARE