Individual
KENNETH E. OSWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
08785
MS
207LP2900X
Pain Medicine (Anesthesiology) Physician
08785
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07726532
—
MS
01
—
P00232389
RAILROAD MEDICARE
MS
01
—
P00604715 GRPDG7781
RAILROAD MEDICARE
MS
Enumeration date
09/28/2006
Last updated
07/08/2013
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