Healthcare Provider Details

I. General information

NPI: 1982180386
Provider Name (Legal Business Name): DANIEL RICHARD DAMITIO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 C T SWITZER SR DR STE 400
BILOXI MS
39531-4535
US

IV. Provider business mailing address

2781 C T SWITZER SR DR STE 400
BILOXI MS
39531-4535
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-4585
  • Fax:
Mailing address:
  • Phone: 228-388-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902702
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: