Provider Demographics
NPI:1720187354
Name:TRUS, JOANNA M (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:TRUS
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 1:4577 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2516
Mailing Address - Country:US
Mailing Address - Phone:228-864-2752
Mailing Address - Fax:
Practice Address - Street 1:4577 13TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2516
Practice Address - Country:US
Practice Address - Phone:228-864-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16887207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122596Medicaid
MS0122596Medicaid
MSF66186Medicare UPIN