Pendergrass, Desiree Buehler

Pendergrass, Desiree Buehler is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Pendergrass, Desiree Buehler can be contacted via phone (601) 815-8982.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-8982
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X H4609 Texas
Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine 2083P0901X H4609 Texas
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 24712 Mississippi
Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine 2083P0901X 24712 Mississippi

Profile Details

NPI number 1255425989
LBN Legal business name Pendergrass, Desiree Buehler
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2006
Last updated Feb 17th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255425989 NPPES
Mississippi MEDICAID 05359595
Mississippi Other 08907561
Mississippi Other 8J1510
Mississippi Other 132232307
Mississippi Other 155349101
Mississippi Other 8G6058
Mississippi Other 200101350A

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