Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 13023 | MS |
NPI | 1013940766 |
---|---|
Provider Name | Dr. Constantine P Zouboukos |
First Address | Flowood, MS 39232-9303 |
Second Address | Flowood, MS 39232-9303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0114454 | (05) | MS |
F95429 | (02) | MS |