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Individual

DR. RISA MORIARITY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17704
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05787589
MS
01
512G700003
MS MEDICARE - GROUP
MS
01
P00462291
RAILROAD MEDICARE
MS
01
P01402393
RAILROAD MEDICARE
MS
Enumeration date
07/08/2006
Last updated
02/12/2015
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