Provider Demographics
NPI:1104899129
Name:FLANNERY, ALPHONSUS LIGOURI (MD)
Entity type:Individual
Prefix:
First Name:ALPHONSUS
Middle Name:LIGOURI
Last Name:FLANNERY
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 1:703 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9302
Mailing Address - Country:US
Mailing Address - Phone:662-284-9906
Mailing Address - Fax:662-284-9908
Practice Address - Street 1:703 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9302
Practice Address - Country:US
Practice Address - Phone:662-284-9906
Practice Address - Fax:662-284-9908
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016221Medicaid
MS082945285Medicare ID - Type Unspecified
MS00016221Medicaid