Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 267192 | MS |
Y | 213EG0000X | General Practice | 267192 | MS |
NPI | 1003002320 |
---|---|
Provider Name | D. Jason Eklund |
First Address | Pearl, MS 39208-4702 |
Second Address | Pearl, MS 39208-4702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 20/09/2007 |