Individual
DR. ANSON L THAGGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-2538
(601) 815-1854
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
13216
MS
2085R0202X
Diagnostic Radiology Physician
Primary
13216
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00203599
—
MS
05
—
179025
—
AL
01
—
P01202306
RAILROAD MEDICARE PTAN
MS
01
—
POO634041
RAILROAD MEDICARE
—
Enumeration date
10/11/2006
Last updated
01/23/2024
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