Individual
ERIC T LENOIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
971 LAKELAND DR STE 657, JACKSON, MS 39216-4608
(601) 200-2780
(601) 200-2788
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00149
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04378509
—
MS
01
—
PAT9103451
TEMPORARY LICENSE NUMBER
FL
Enumeration date
09/15/2005
Last updated
02/26/2019
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