Provider Demographics
NPI:1881673648
Name:HAUSMANN, JAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:M
Last Name:HAUSMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:M
Other - Last Name:HORNBUCKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:JACKSON-HINDS COMPREHENSIVE HEALTH CENTER
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-709-5130
Mailing Address - Fax:601-709-5141
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:JACKSON-HINDS COMPREHENSIVE HEALTH CENTER
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-709-5130
Practice Address - Fax:601-709-5141
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13821207R00000X
TXL9234207R00000X
MS16219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07303594Medicaid
TN3161286Medicare PIN
TX8L0156Medicare PIN
TNB02872Medicare UPIN
110237306Medicare PIN
MS07303594Medicaid