Healthcare Provider Details

I. General information

NPI: 1518353705
Provider Name (Legal Business Name): JIGAR RAMESHBHAI DESAI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4996
US

IV. Provider business mailing address

4413 MEADOW LAKE DR
TUPELO MS
38801-9495
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-7611
  • Fax:
Mailing address:
  • Phone: 732-331-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26570
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: