Healthcare Provider Details

I. General information

NPI: 1043399223
Provider Name (Legal Business Name): DAVIS HUTTO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

22 DOCTORS DR SUITE C
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-0563
  • Fax: 228-818-0519
Mailing address:
  • Phone: 228-818-0563
  • Fax: 228-818-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR553557
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: