Provider Demographics
NPI:1437375177
Name:JUGUILON HAVAS, BLANCHE C (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:C
Last Name:JUGUILON HAVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180B DEBUYS RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531
Mailing Address - Country:US
Mailing Address - Phone:228-388-7989
Mailing Address - Fax:
Practice Address - Street 1:180B DEBUYS RD
Practice Address - Street 2:STE 104
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-388-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS118772084P0800X
DC16183 MD2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019142Medicaid
MS00019142Medicaid