Fomin, Alexey

Fomin, Alexey is an individual health care provider with primary practice located at 104 Millsaps Dr , Hattiesburg MS 39402-1328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Fomin, Alexey can be contacted via phone (601) 288-7500.

Contact Information

Primary practice address
104 Millsaps Dr Hattiesburg MS 39402-1328
Phone: (601) 288-7500
Fax: (601) 268-5179
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 47117 Kentucky
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 24153 Mississippi

Profile Details

NPI number 1700211141
LBN Legal business name Fomin, Alexey
Credentials M.D., PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 4th, 2013
Last updated Jul 9th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700211141 NPPES
Mississippi MEDICAID 04537068

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