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General NPI Number Information
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NPI Number | 1952802795
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Entity Type | Individual
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Provider Name | DAVID T RIGDON
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Gender | Male
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 301 FISHER ST RM GG700
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City | KEESLER AFB
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-377-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 3704 QUEEN ELIZABETH DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3341
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Country | US
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Telephone | 228-872-3262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 07356
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License Number State | MS
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