Organization
TUPELO ANESTHESIA GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN H DOUGLAS III MD (SECRETARY)
(662) 377-4394
Entity
Organization
Contact information
Practice address
830 SOUTH GLOSTER, TUPELO, MS 38801
(662) 377-4394
(662) 377-7045
Mailing address
PO BOX 3294, TUPELO, MS 38803-3294
(662) 377-4394
(662) 377-7045
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013131
—
MS
Enumeration date
07/02/2006
Last updated
11/11/2010
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