Organization
TUPELO MEDICAL GROUP, LLC
Active
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
Update your record
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