Jerry Lee Stork, P.A. Valid NPI

Individual provider · Physician Assistant · Hattiesburg, MS

NPI

1467479550

Type

Individual (Type 1)

Primary specialty

Physician Assistant

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363A00000X

License number

PA00079 (MS)

Sex

Male

Sole proprietor

No

Enumerated

2006-07-16

Last updated

2021-10-19