Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 15530 | MS |
NPI | 1821182080 |
---|---|
Provider Name | Mr. Jeptha Newton Cole |
First Address | Flowood, MS 39232-9526 |
Second Address | Jackson, MS 39232-9532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126043 | (05) | MS |
G88845 | (02) | MS |