Basic Information
| Provider Information | |||||||||
| NPI: | 1497765705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SADDLER | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 RIVER OAKS DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390465324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018554717 | ||||||||
| FaxNumber: | 6018593451 | ||||||||
| Practice Location | |||||||||
| Address1: | 163 RIVER OAKS DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390465324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018554717 | ||||||||
| FaxNumber: | 6018593451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 08627 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01383132 | 01 | MS | RAILROAD MEDICARE | OTHER | 00019712 | 05 | MS | MEDICAID |