Healthcare Provider Details

I. General information

NPI: 1346466596
Provider Name (Legal Business Name): ERIC VINCENT PLOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15190 COMMUNITY RD STE 230
GULFPORT MS
39503-3483
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-7104
  • Fax: 228-539-6766
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number18573
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: