Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 09298 | MS |
NPI | 1124104765 |
---|---|
Provider Name | Mitzi Gail Ferguson |
First Address | Pearl, MS 39288-5569 |
Second Address | Jackson, MS 39216-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00122986 | (05) | MS |