Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 26731 | MS |
NPI | 1063777472 |
---|---|
Provider Name | Dr. Joaquin Andres Hidalgo |
First Address | Tupelo, MS 38801-6584 |
Second Address | Tupelo, MS 38801-6584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 14/06/2019 |