Healthcare Provider Details

I. General information

NPI: 1326154980
Provider Name (Legal Business Name): SARAH J BROOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 208
JACKSON MS
39202-1651
US

IV. Provider business mailing address

PO BOX 23996
JACKSON MS
39225-3996
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-2273
  • Fax: 601-714-3415
Mailing address:
  • Phone: 601-352-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number08705
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: