Provider Demographics
NPI:1760495071
Name:GISPEN, JEAN GUYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:GUYTON
Last Name:GISPEN
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677-1848
Mailing Address - Country:US
Mailing Address - Phone:662-915-6550
Mailing Address - Fax:662-915-2022
Practice Address - Street 1:EMPLOYEE HEALTH SERVICE, V. B. HARRISON BUILDING
Practice Address - Street 2:REBEL DRIVE
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-6550
Practice Address - Fax:662-915-2022
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11113207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB30101Medicare UPIN