Healthcare Provider Details

I. General information

NPI: 1295779007
Provider Name (Legal Business Name): BRIAN RAYMOND PITRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MARKS RD
OCEAN SPRINGS MS
39564-4351
US

IV. Provider business mailing address

19 MARKS RD
OCEAN SPRINGS MS
39564-4351
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-4949
  • Fax: 228-872-4951
Mailing address:
  • Phone: 228-872-4949
  • Fax: 228-872-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13592
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13592
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: