Organization
MISSISSIPPI ASTHMA & ALLERGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID L MOAK (PRACTICE ADMINISTRATOR)
(601) 354-4836
Entity
Organization
Contact information
Practice address
1513 LAKELAND DR, STE 100, JACKSON, MS 39216-4829
(601) 354-4836
(601) 354-2619
Mailing address
1513 LAKELAND DR, STE 101, JACKSON, MS 39216-4829
(601) 354-4836
(601) 354-2619
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030001646
RR MEDICARE
MS
01
—
030002483
RR MEDICARE
MS
01
—
030003287
RR MEDICARE
MS
01
—
P00236071
RR MEDICARE
MS
Enumeration date
12/19/2005
Last updated
02/16/2010
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