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Individual

CANON JADE BEISSEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
35 W MONROE ST, GRENADA, MS 38901-5222
(662) 226-8229
(662) 226-3300
Mailing address
PO BOX 1041, GRENADA, MS 38902-1041
(662) 226-9866
(662) 453-4546

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
16518
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
06050013
MS
Enumeration date
12/14/2006
Last updated
07/09/2007
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