Healthcare Provider Details

I. General information

NPI: 1689763856
Provider Name (Legal Business Name): VINOD KUMAR ANAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL STREET SUITE # 602
JACKSON MS
39202
US

IV. Provider business mailing address

501 MARSHALL STREET PO BOX 1000 SUITE # 602
JACKSON MS
39202
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-1910
  • Fax: 601-969-1913
Mailing address:
  • Phone: 601-969-1910
  • Fax: 601-969-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number09754
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number09754
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number09754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: