Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 10460 | MS |
NPI | 1003826272 |
---|---|
Provider Name | Jo P Deal |
First Address | Champions Gate, FL 33896-8310 |
Second Address | Jackson, MS 39216-4610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00018389 | (05) | MS |
B30441 | (02) | |
P01065367 | RAILROAD MEDICARE (01) | MS |