Individual
DOMENIC P ESPOSITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, N703 NEUROSURGERY DEPARTMENT, JACKSON, MS 39216-4500
(601) 984-5706
(601) 984-6491
Mailing address
2500 N STATE ST, N703 NEUROSURGERY DEPARTMENT, JACKSON, MS 39216-4500
(601) 984-5706
(601) 984-6491
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
16712
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122202
—
MS
01
—
140000133
2007 MCR
MS
01
—
140006643
RR PTAN
MS
Enumeration date
05/30/2006
Last updated
11/14/2008
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