Provider Demographics
NPI:1215146253
Name:LUNDY, ROBERT B JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:LUNDY
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 1:223 HIGHLAND HILLS LN
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9529
Mailing Address - Country:US
Mailing Address - Phone:601-879-8267
Mailing Address - Fax:
Practice Address - Street 1:223 HIGHLAND HILLS LN
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-9529
Practice Address - Country:US
Practice Address - Phone:601-879-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS081692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014275Medicaid
MS0014275Medicaid
MS260260888Medicare ID - Type Unspecified