Provider Demographics
NPI:1043267719
Name:PARENT, ANDREW DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DENNIS
Last Name:PARENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5706
Mailing Address - Fax:601-984-6491
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5706
Practice Address - Fax:601-984-6491
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08228207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08228OtherSTATE LICENSE
MS142945605OtherRR PTAN
MS00016928Medicaid
MS140000084Other2007 MCR
MS08228OtherSTATE LICENSE
MS302I147058Medicare PIN
MS00016928Medicaid