Individual
JOHN W BETHEA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
13990
MS
207L00000X
Anesthesiology Physician
35077616
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09855207
—
MS
05
—
156052
—
AL
05
—
2214142
—
OH
Enumeration date
07/26/2005
Last updated
02/20/2014
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