Provider Demographics
NPI:1366551079
Name:PRICE, E J JR (MD)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:J
Last Name:PRICE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0848
Mailing Address - Country:US
Mailing Address - Phone:601-684-4443
Mailing Address - Fax:601-684-4491
Practice Address - Street 1:300 RAWLS DRIVE
Practice Address - Street 2:SUITE 900
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-684-4443
Practice Address - Fax:601-684-4491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05010207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115569Medicaid
MS160042396OtherRAILROAD MEDICARE
MS160000089Medicare PIN
MS00115569Medicaid