Individual
DR. LAURA RICHARDS VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5080
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5080
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18941
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00273859
—
MS
01
—
P01203291
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/09/2006
Last updated
07/24/2015
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