Provider Demographics
NPI:1972527372
Name:BELKNAP, AMOS (MD)
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:BELKNAP
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 1:342 GILCHRIST DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6671
Mailing Address - Country:US
Mailing Address - Phone:601-939-0700
Mailing Address - Fax:601-939-8654
Practice Address - Street 1:342 GILCHRIST DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6671
Practice Address - Country:US
Practice Address - Phone:601-939-0700
Practice Address - Fax:601-939-8654
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122356Medicaid
MS0122356Medicaid