Healthcare Provider Details

I. General information

NPI: 1558343392
Provider Name (Legal Business Name): STEPHEN K SENTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 3RD ST
BELMONT MS
38827-7737
US

IV. Provider business mailing address

PO BOX 549 26 3RD ST
BELMONT MS
38827-0549
US

V. Phone/Fax

Practice location:
  • Phone: 662-454-7170
  • Fax: 662-454-7177
Mailing address:
  • Phone: 662-454-7170
  • Fax: 662-454-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202843240
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: