Individual
TELCIANE VESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1860 CHADWICK DR STE 351, JACKSON, MS 39204-3472
(601) 376-1288
Mailing address
PO BOX 321359, FLOWOOD, MS 39232-1359
(601) 933-6593
(601) 933-6596
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
074924
GA
207RG0100X
Gastroenterology Physician
2014015595
MO
207RG0100X
Gastroenterology Physician
Primary
21204
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08278258
—
MS
05
—
1295932168
—
MO
Enumeration date
07/02/2007
Last updated
03/25/2021
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