Provider Demographics
NPI:1598855546
Name:SEGREST, DAVID RONALD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RONALD
Last Name:SEGREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 N STATE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1658
Mailing Address - Country:US
Mailing Address - Phone:601-355-9537
Mailing Address - Fax:601-355-6893
Practice Address - Street 1:1421 N STATE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1658
Practice Address - Country:US
Practice Address - Phone:601-355-9537
Practice Address - Fax:601-355-6893
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08044207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016082Medicaid
MSDC7890OtherRAILROAD MEDICARE
MS180000371OtherMEDICARE
MS00016082Medicaid
MS180000371OtherMEDICARE