Provider Demographics
NPI:1912006859
Name:MONROE, LINDA P (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:MONROE
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 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DIVISION OF HYPERTENSION
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-984-6850
Mailing Address - Fax:601-984-6853
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF HYPERTENSION
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4505
Practice Address - Country:US
Practice Address - Phone:601-984-6850
Practice Address - Fax:601-984-6853
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11391207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2408429Medicaid
MSP01212516OtherRAILROAD MEDICARE
MS08751806Medicaid
MS08751806Medicaid
MS512I110340Medicare PIN
LA2408429Medicaid
TN110170386Medicare PIN
TND93207Medicare UPIN
MS08751806Medicaid
TNCE0561Medicare PIN
TN3072542OtherBCBSTN
TN3710089Medicaid
TN3710089Medicare PIN
TN3044179Medicare PIN
MS302I117080Medicare PIN