Provider Demographics
NPI:1699712091
Name:PANNI, MOEEN K (MD)
Entity type:Individual
Prefix:
First Name:MOEEN
Middle Name:K
Last Name:PANNI
Suffix:
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 1:2500 N. STATE ST
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-5931
Mailing Address - Fax:601-984-5939
Practice Address - Street 1:2500 N. STATE ST, UMMC
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-5931
Practice Address - Fax:601-984-5939
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2438207L00000X
FLME94159207L00000X
MS22077207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176445801Medicaid
MS04607335Medicaid
TX8S3255OtherBCBS
MS302I0523866Medicare PIN
TX8D9699Medicare PIN
TX8S3255OtherBCBS
MS04607335Medicaid