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Organization

UNIVERSITY INTERNAL MEDICINE ASSOC LLP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RICHARD DESHAZO MD (MANAGING PARTNER)
(601) 987-3988
Entity
Organization

Contact information

Practice address
2500 N STATE ST, DEPARTMENT OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5600
Mailing address
1867 CRANE RIDGE DR, STE 150-A UNIVERSITY INTERNAL MEDICINE ASSOCIATES, LLP, JACKSON, MS 39216-4982
(601) 987-3988
(601) 987-4165

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MS
207R00000X
Internal Medicine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09012352
MS
Enumeration date
06/13/2006
Last updated
07/21/2022
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