Provider Demographics
NPI:1558628727
Name:MCLEROY, ROBERT LEE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:MCLEROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-7363
Mailing Address - Country:US
Mailing Address - Phone:662-838-4500
Mailing Address - Fax:662-838-4502
Practice Address - Street 1:28 CHASE ST
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-7363
Practice Address - Country:US
Practice Address - Phone:662-838-4500
Practice Address - Fax:662-838-4502
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor