Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 10479 | MS |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 10479 | MS |
NPI | 1629058375 |
---|---|
Provider Name | Dr. Randall L. Nance |
First Address | Oxford, MS 38655-2760 |
Second Address | Batesville, MS 38606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116402 | (05) | MS |
B64155 | (02) |