Provider Demographics
NPI:1366686354
Name:DEMENT, FRANK EUGENE III (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:EUGENE
Last Name:DEMENT
Suffix:III
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 1:2313 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1805
Mailing Address - Country:US
Mailing Address - Phone:601-649-2775
Mailing Address - Fax:601-649-2686
Practice Address - Street 1:2313 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1805
Practice Address - Country:US
Practice Address - Phone:601-649-2775
Practice Address - Fax:601-649-2686
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06438003Medicaid
MS6026209OtherHEALTHSPRING
MS6635899OtherCIGNA
MS5405398OtherAETNA
MS302I370266Medicare PIN