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General NPI Number Information
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NPI Number | 1376332387
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Entity Type | Organization
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Legal Business Name | MIDSOUTH PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 365 N PARKWAY STE 200
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City | JACKSON
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State | TN
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Zip | 38305-2876
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Country | US
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Telephone | 731-426-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 106 N SPRING DR
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City | JACKSON
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State | TN
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Zip | 38305-8116
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Country | US
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Telephone | 346-717-7607
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JORDI PUENTE ESPEL
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Credential | MD
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Telephone | 346-717-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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