Individual
DR. JOHN KEITH MANSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE STREET, JACKSON, MS 39216-4500
(601) 984-5602
(601) 984-6439
Mailing address
2500 N STATE STREET, JACKSON, MS 39216-4500
(601) 984-5602
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
08768
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115528
—
MS
01
—
08768
FREE CLINIC
MS
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P01064280
MEDICARE RAILROAD
MN
Enumeration date
12/24/2007
Last updated
12/08/2016
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