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NPI Code Detail

MEDICARE: DR. JACK Q CAUSEY II MD

MEDICARE: DR. JACK Q CAUSEY II MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician11872MS
2174400000XSpecialist11872MS

General Provider Information

NPI Number : 1790777142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK Q CAUSEY II MD
Provider Business Mailing Address
First Line : 19648 CHAMPION CIR
Second Line :
City : GULFPORT
State : MS
Zip : 39503-7668
Country : US
Telephone Number : 601-865-3653
Fax Number : 228-575-2380
Provider Business Practice Location Address
First Line : 4500 13TH ST
Second Line :
City : GULFPORT
State : MS
Zip : 39501-2515
Country : US
Telephone Number : 228-867-4000
Fax Number : 228-575-2380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2005
Last Update Date : 11/07/2007

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