Individual
DR. JOHN PETTEY SANDIFER JR.
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) 984-5570
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5570
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2007-01565
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I937817
MEDICARE PTAN
MS
05
—
5908150
—
NC
01
—
P00844839
MEDICARE RAILROAD
MS
Enumeration date
10/25/2007
Last updated
06/27/2012
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