Provider Demographics
NPI:1285781153
Name:MOCK-MUHAMMAD, BERTHRONE LACALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:BERTHRONE
Middle Name:LACALVIN
Last Name:MOCK-MUHAMMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERTHRONE
Other - Middle Name:LACALVIN
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:406 BRIARWOOD DR STE 401
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3063
Mailing Address - Country:US
Mailing Address - Phone:601-707-7899
Mailing Address - Fax:866-304-0148
Practice Address - Street 1:406 BRIARWOOD DR STE 401
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3063
Practice Address - Country:US
Practice Address - Phone:601-707-7899
Practice Address - Fax:866-304-0148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 2251C2600X, 2251E1300X, 225700000X
MS20402207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist