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Contact Information

DESIREE B PENDERGRASS, MD
2500 N STATE ST
JACKSON, MS39216-4500
 Phone: 601-815-8982
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Public Health & General Preventive Medicine

2083P0901X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for DESIREE B PENDERGRASS · (Female)

NPI # 1255425989
Status Active
Credentials MD
Entity Individual
Enumeration date 10/03/2006
Last updated 02/17/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 24712
  • TX License # H4609
  • MS Medicaid 05359595
  • TX Other 8G6058 BC/BS
  • TX Other 155349101 FIRSTCARE MEDICAID
  • TX Other 8J1510 MEDICARE
  • TX Other 08907561 NM MEDICAID
  • TX Other 200101350A OK MEDICARE
  • TX Other 132232307 TMHP
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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