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NPI Code Detail

MEDICARE: MR. DAVID B UTTERBACK MD

MEDICARE: MR. DAVID B UTTERBACK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician15753MS

General Provider Information

NPI Number : 1851327555
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID B UTTERBACK MD
Provider Business Mailing Address
First Line : PO BOX 789
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39566-0789
Country : US
Telephone Number : 228-872-9388
Fax Number :
Provider Business Practice Location Address
First Line : 351 COWAN RD
Second Line :
City : GULFPORT
State : MS
Zip : 39507-2019
Country : US
Telephone Number : 228-896-1120
Fax Number : 228-896-1332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 03/30/2018

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