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Organization

TUPELO MEDICAL GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JULIAN D. LODEN M.D. (VICE PRESIDENT)
(662) 407-2528
Entity
Organization

Contact information

Practice address
1265 CLIFF GOOKIN BOULEVARD, TUPELO, MS 38801-6749
(662) 840-2131
(662) 840-2522
Mailing address
1265 CLIFF GOOKIN BOULEVARD, TUPELO, MS 38801-6749
(662) 407-2528
(662) 620-9915

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015601
MS
Enumeration date
06/04/2006
Last updated
12/12/2011
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