Individual
ANGELA R SUBAUSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5525
(601) 984-6439
Mailing address
2500 NORTH STATE STREET, HYPERTENSION, JACKSON, MS 39216
(601) 984-5525
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301080359
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
22041
MS
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
4301080359
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09232094
—
MS
05
—
4641855
—
MI
Enumeration date
10/23/2006
Last updated
04/09/2014
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