Provider Demographics
NPI:1558421651
Name:AUZENNE, GREGORY ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALVIN
Last Name:AUZENNE
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 649107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264
Mailing Address - Country:US
Mailing Address - Phone:601-286-5477
Mailing Address - Fax:601-286-5825
Practice Address - Street 1:4803 29TH AVE STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2675
Practice Address - Country:US
Practice Address - Phone:601-286-5477
Practice Address - Fax:601-286-5825
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20220207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07631726Medicaid