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Contact Information

LAFAYETTE PEDIATRIC CLINIC
2166 S LAMAR BLVD
OXFORD, MS38655-5224
 Phone: 662-236-3939
 Fax: 662-236-3924
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for LAFAYETTE PEDIATRIC CLINIC · (Female)

NPI Number 1144418609
Status Active
Credentials
Entity Individual
Enumeration date 10/10/2007
Last updated 03/17/2010 - About 16 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # 17111
  • MS Medicaid 00125498
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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