Provider Demographics
NPI:1982656773
Name:SUGG, REBECCA MIXON (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MIXON
Last Name:SUGG
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 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5517
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL241712084N0400X
NC2007-008352084N0400X
MO20090118132084V0102X
KS04337962084V0102X
MS215252084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907253Medicaid
AL051528667OtherBLUE CROSS
NCP00456683OtherRAILROAD MEDICARE
AL051528665OtherBLUE CROSS
MO900433202Medicare PIN
MS302I137025Medicare PIN
MS302I138623Medicare PIN
NCP00456683OtherRAILROAD MEDICARE
NC5907253Medicaid