Individual
JENNA L DEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-9347
(601) 984-2086
Mailing address
2500 N STATE ST, CBO-SUITE 4300, JACKSON, MS 39216-4500
(601) 815-9347
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23448
MS
208000000X
Pediatrics Physician
T-2546
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03271232
—
MS
Enumeration date
06/29/2012
Last updated
01/29/2021
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