Healthcare Provider Details

I. General information

NPI: 1477649465
Provider Name (Legal Business Name): GIORGIO M ARU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST R00M L210
JACKSON MS
39216-4500
US

IV. Provider business mailing address

PO BOX 24146
JACKSON MS
39225-4146
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5170
  • Fax: 601-984-5198
Mailing address:
  • Phone: 601-925-6805
  • Fax: 601-926-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number6210
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: