Provider Demographics
NPI:1013008242
Name:LANCON, JOHN ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADRIAN
Last Name:LANCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-5955
Mailing Address - Fax:601-200-5957
Practice Address - Street 1:971 LAKELAND DR STE 1250
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-200-5955
Practice Address - Fax:601-200-5957
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS13239207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120913Medicaid
MS00120913Medicaid