Individual
MICHAEL NASH GLEASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
969 LAKELAND DR, EMERGENCY DEPARTMENT, JACKSON, MS 39216-4606
(601) 200-6175
(601) 200-2020
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-6175
(601) 200-2020
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19661
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05103781
—
MS
01
—
512I930442
MEDICARE PTAN#
MS
Enumeration date
06/04/2007
Last updated
06/05/2020
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