Provider Demographics
NPI:1861496465
Name:HOUSTON, GERRY ANN (MD)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:ANN
Last Name:HOUSTON
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 1:450 TOWNE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4804
Mailing Address - Country:US
Mailing Address - Phone:601-898-1053
Mailing Address - Fax:
Practice Address - Street 1:450 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4804
Practice Address - Country:US
Practice Address - Phone:601-898-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08360207RH0003X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4223312OtherAETNA HEALTHCARE
MS00115432Medicaid
LA1967343Medicaid
B30945Medicare UPIN
LA1967343Medicaid
110052714Medicare PIN