Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 22894 | MS |
Y | 111NI0900X | Internist | 22894 | MS |
NPI | 1003103516 |
---|---|
Provider Name | Dr. Rebecca Chick Pace |
First Address | Memphis, TN 38120-9446 |
Second Address | Jackson, MS 39202-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 15/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22894 | MS PERMANENT MEDICAL LICENSE (01) | MS |