Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 08228 | MS |
NPI | 1043267719 |
---|---|
Provider Name | Andrew Dennis Parent |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 12/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00016928 | (05) | MS |
08228 | STATE LICENSE (01) | MS |
140000084 | 2007 MCR (01) | MS |
142945605 | RR PTAN (01) | MS |