Individual
ROWDY CHANCE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5153
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5153
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
T-4299
MS
363A00000X
Physician Assistant
PA00186
MS
363A00000X
Physician Assistant
PA976
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04402871
—
MS
Enumeration date
09/23/2013
Last updated
07/21/2021
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