Individual
NEVILLE R. WICHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE ST., JACKSON, MS 39216
(601) 984-2538
(601) 815-1854
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 815-4775
(601) 984-6451
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
00021845
AL
2085R0202X
Diagnostic Radiology Physician
Primary
13966
MS
2085R0202X
Diagnostic Radiology Physician
ME88885
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25025853
—
MS
01
—
512G700003
MS MEDICARE - GROUP
MS
01
—
CD5130
GROUP #
—
01
—
DG7781
RAILROAD - GROUP
—
01
—
P00462360
RAILROAD MEDICARE
—
01
—
P00621714
RAILROAD MEDICARE
—
Enumeration date
02/06/2006
Last updated
11/06/2014
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