Provider Demographics
NPI:1124078944
Name:MEACHAM, ROBERT RHODES III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RHODES
Last Name:MEACHAM
Suffix:III
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 1:124 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2240
Mailing Address - Country:US
Mailing Address - Phone:662-429-5221
Mailing Address - Fax:662-429-7917
Practice Address - Street 1:124 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2240
Practice Address - Country:US
Practice Address - Phone:662-429-5221
Practice Address - Fax:662-429-7917
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14643207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119312Medicaid
MSG64710Medicare UPIN
MS00119312Medicaid