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Physicians Internal Medicine Nephrology

Provider NPI: 1053533406

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 601-833-3822  Fax: 601-835-4330

Business Mailing Address:
4701 LAKELAND DR APT 28-C FLOWOOD, MS 39232-9506 US
Tel: 601-405-1593  Fax: 601-984-5675

NPI Information:
NPI: 1053533406
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Internal Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207RN0300X





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