Provider Demographics
NPI:1881623650
Name:DUNCOMBE, VANESSA LYNN (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:DUNCOMBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 REYNOIR ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4109
Mailing Address - Country:US
Mailing Address - Phone:228-435-6505
Mailing Address - Fax:228-436-1666
Practice Address - Street 1:3920 PROMENADE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5368
Practice Address - Country:US
Practice Address - Phone:228-456-0173
Practice Address - Fax:228-456-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS17641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125820Medicaid
MS00125820Medicaid
MS080004298Medicare PIN