Healthcare Provider Details

I. General information

NPI: 1174928865
Provider Name (Legal Business Name): JAFET A OJEDA RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
BILOXI MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST
BILOXI MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01079262A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01079262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: