Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD441215 | PA |
N | 208600000X | Surgeon | MD441215 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 21552 | MS |
NPI | 1043294432 |
---|---|
Provider Name | Pierre Edouard De Delva |
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 | 30/11/2005 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01195517 | RAILROAD MEDICARE PTAN (01) | MS |