Provider Demographics
NPI:1538165980
Name:DAGGETT, ROBERT B (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:DAGGETT
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 1:2024 15TH ST
Mailing Address - Street 2:FL 2
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-553-2000
Mailing Address - Fax:601-553-6857
Practice Address - Street 1:2024 15TH ST
Practice Address - Street 2:FL 2
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4130
Practice Address - Country:US
Practice Address - Phone:601-553-2000
Practice Address - Fax:601-553-6857
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13128207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123658Medicaid
MS1110400001Medicare NSC
MS660000490Medicare PIN
MS00123658Medicaid
MS660000041Medicare PIN