Individual
DR. MICHAEL STACY THAGGARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1203 24TH AVE, MERIDIAN, MS 39301-3926
(601) 693-5862
(601) 693-9314
Mailing address
PO BOX 5653, MERIDIAN, MS 39302-5653
(601) 693-5862
(601) 693-9314
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12892
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113689
—
MS
Enumeration date
11/10/2005
Last updated
07/08/2007
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