1457364556 NPI number — DR. L. CAMERON PIMPERL M.D.

Table of content: DR. L. CAMERON PIMPERL M.D. (NPI 1457364556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457364556 NPI number — DR. L. CAMERON PIMPERL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIMPERL
Provider First Name:
L.
Provider Middle Name:
CAMERON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457364556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 S 13TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39440-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-2999
Provider Business Mailing Address Fax Number:
601-425-3286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 S 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-425-2999
Provider Business Practice Location Address Fax Number:
601-425-3286
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  19054 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19054 . This is a "MISSISSIPPI MEDICAL LICEN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 302I922979 . This is a "PIMPRELL MEDICARE PTAN EFFECTIVE 05/19/2012" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 302G702986 . This is a "ONCOLOGICS LLC GROUP PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 04150773 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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