=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659303303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON TRIPPE MCNEESE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 09/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 OCEAN SPRINGS RD
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-875-3033
-----------------------------------------------------
Fax | 228-875-3989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1270 OCEAN SPRINGS RD
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-875-3033
-----------------------------------------------------
Fax | 228-875-3989
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 19088
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------