Individual
IRINA V BORISSOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
2500 N STATE ST, DEPT. OF ANESTHESIOLOGY, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Mailing address
2500 N STATE ST, DEPT. OF ANESTHESIOLOGY, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
N1268
TX
207LP3000X
Pediatric Anesthesiology Physician
Primary
21550
MS
207LP3000X
Pediatric Anesthesiology Physician
N1268
TX
208000000X
Pediatrics Physician
N1268
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06276558
—
MS
05
—
197750601
—
TX
05
—
197750605
—
TX
01
—
197750606
CSHCN
TX
01
—
302I050811
MEDICARE PTAN
MS
01
—
N1268
STATE LICENSE
TX
Enumeration date
03/08/2006
Last updated
06/14/2012
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