Provider Demographics
NPI:1275744864
Name:HENSON, ZEB K (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEB
Middle Name:K
Last Name:HENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DIVISION OF GENERAL INTERNAL MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5770
Mailing Address - Fax:601-984-6853
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF INTERNAL MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5770
Practice Address - Fax:601-984-6853
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS19909207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2142763Medicaid
MS02930560Medicaid
AL185909Medicaid
MSP01118800OtherRAILROAD MEDICARE PTAN
LA2142763Medicaid
MSP01118800OtherRAILROAD MEDICARE PTAN