MEDICARE: JOHN E STUDDARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	07721	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225022213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E STUDDARD M.D.

Provider Business Mailing Address
First Line	:	971 LAKELAND DR
Second Line	:	SUITE 1052
City	:	JACKSON
State	:	MS
Zip	:	39216-4643
Country	:	US
Telephone Number	:	601-981-9503
Fax Number	:	601-951-7895

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR
Second Line	:	SUITE 1052
City	:	JACKSON
State	:	MS
Zip	:	39216-4643
Country	:	US
Telephone Number	:	601-981-9503
Fax Number	:	601-951-7895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	10/31/2011

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Directions to “ JOHN E STUDDARD M.D.” Practice Location

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