Healthcare Provider Details

I. General information

NPI: 1932273984
Provider Name (Legal Business Name): MARIANO L ORCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHADWICK DR STE 351
JACKSON MS
39204-3472
US

IV. Provider business mailing address

PO BOX 321359
FLOWOOD MS
39232-1359
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1288
  • Fax: 601-376-1293
Mailing address:
  • Phone: 601-936-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01028016A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01028016A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number27198
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: