Healthcare Provider Details

I. General information

NPI: 1134236128
Provider Name (Legal Business Name): ALFREDO HERNAN FIGUEROA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 104
JACKSON MS
39202-1651
US

IV. Provider business mailing address

501 MARSHALL ST STE 104
JACKSON MS
39202-1651
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-6404
  • Fax: 601-973-4541
Mailing address:
  • Phone: 601-969-6404
  • Fax: 601-973-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11545
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: