Provider Demographics
NPI:1184652745
Name:SAULS, JEFFREY LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LLOYD
Last Name:SAULS
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:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1527
Mailing Address - Country:US
Mailing Address - Phone:228-875-0171
Mailing Address - Fax:228-875-0172
Practice Address - Street 1:1151 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-875-0171
Practice Address - Fax:228-875-0172
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013328Medicaid
MS300000100Medicare ID - Type UnspecifiedPROVIDER NUMBER
MS00013328Medicaid