NPI 1619140399

Vicksburg Allergy and Asthma

Organisation Allergy & Immunology Physician Vicksburg, MS

Practice location

Address: 104 McAuley Dr, Vicksburg, MS 39183-2825
Phone: (601) 636-0097
Fax: (601) 629-9969
Mailing address: 107 Carlton Place Dr, Vicksburg, MS 39180-1822

Authorised official

Name: Timothy Kerut
Title: President
Phone: (601) 636-0097

Registered specialties

Allergy & Immunology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207K00000X Licence 11047 (MS)

Other Allergy & Immunology providers in Mississippi →

Registry record

NPI: 1619140399
Entity type: Organization
NPI issued: 2 Apr 2008
Record last updated: 2 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.