Individual
PETER BRATOVANOV ILIEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1196
(601) 984-5939
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1196
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24023
MS
207L00000X
Anesthesiology Physician
254809
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02704031
—
MS
Enumeration date
09/14/2009
Last updated
10/24/2024
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