Individual
DR. LICY LORENA YANES CARDOZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5601
(601) 984-6665
Mailing address
2500 N STATE ST, DEPARTMENT OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5601
(601) 984-6665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22850
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07121037
—
MS
Enumeration date
07/02/2010
Last updated
07/02/2015
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