Individual
MITCHELL O'NEAL GLOVER IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE STREET, UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, JACKSON, MS 39216-4505
(601) 984-5582
Mailing address
2500 NORTH STATE STREET, UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, JACKSON, MS 39216-4505
(601) 984-5582
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22834
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08632351
—
MS
05
—
195136
—
AL
01
—
P01627828
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/13/2011
Last updated
03/06/2017
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