Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 06945 | MS |
NPI | 1245499110 |
---|---|
Provider Name | Dr. John P Mladineo |
First Address | Jackson, MS 39296-4665 |
Second Address | Jackson, MS 39216-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 05/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66087 | (02) | MS |