Julian Jerrod Jesubatham MD

NPI 1659682904 - Internal Medicine - 207R00000X

NPI Details
NPI 1659682904
Gender Male
Enumeration Date 07/01/2010
Last Updated 09/01/2015
Entity Type Individual
Active Over 6 years ago
Practice Location
785 OHIO AVE
SUITE 3D
CLARKSDALE MS, 38614-6217, US
Phone (662) 627-7726
Fax
Business Location
604 HOLMAN AVE
CLEVELAND MS, 38732-2012, US
Phone (662) 545-4369
Fax
Toxanomy
Taxonomy Code 207R00000X
License State Mississippi
License Number 21200
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According to our database, Dr. Julian Jerrod Jesubatham MD NPI is 1659682904, taxonomy code is 207R00000X and license number is 21200, license state is located at Mississippi. Julian Jerrod Jesubatham MD physically located at 785 Ohio Ave, Clarksdale MS, 38614-6217. NPI Number Julian Jerrod Jesubatham MD has the Individual type.

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1659682904 NPI number is provided on an as is basis without warranty of any kind. 1659682904 is maintained by the National Plan & Provider Enumeration System. The contents of Julian Jerrod Jesubatham MD are for informational purposes only.