Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 21415 | MS |
N | 2086X0206X | Surgical Oncologist | P6488 | TX |
NPI | 1013132406 |
---|---|
Provider Name | Dr. Wayne Shannon Orr III |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 29/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02102268 | (05) | MS |
333731301 | (05) | TX |