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Individual

JE SONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
19424 SAUCIER LIZANA RD, SAUCIER, MS 39574-9667
(228) 206-2681
Mailing address
P.O. BOX 1036, PICAYUNE, MS 39466-1036
(228) 206-2681

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
17284
MS
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
17284
MS
208600000X
Surgery Physician
17284
MS
208D00000X
General Practice Physician
Primary
17284
MS
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
17284
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04906363
MS
Enumeration date
02/01/2007
Last updated
01/19/2011
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