Provider Demographics
NPI:1659367159
Name:VARELA, PABLO 'PAUL' Y (MD)
Entity Type:Individual
Prefix:
First Name:PABLO 'PAUL'
Middle Name:Y
Last Name:VARELA
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 1:1800 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4158
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-9541
Practice Address - Fax:601-703-9947
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06966207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
73011395OtherBLUE CROSS OF AL
000037529OtherMEDICAID OF AL
MS00115346Medicaid
100003736OtherRAILROAD MEDICARE
73011395OtherBLUE CROSS OF AL
MS00115346Medicaid