Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 19117 | MS |
NPI | 1023123353 |
---|---|
Provider Name | Joshua A Maksi |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Hattiesburg, MS 39401-7246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 22/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05189569 | (05) | MS |
1055646 | (05) | LA |
3483906 | AMERICAN ADMIN GROUP (01) | MS |
I45861 | (02) |