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General NPI Number Information
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NPI Number | 1194124834
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Entity Type | Organization
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Legal Business Name | DAVID B ROY DO PA
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 201 S MAIN ST
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City | PETAL
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State | MS
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Zip | 39465-2362
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Country | US
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Telephone | 318-884-9706
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Fax |
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Provider Business Mailing Address
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Address Line | 102 E HOSPITAL DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1310
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Country | US
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Telephone | 601-475-9968
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Fax | 601-475-9969
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Authorized Official
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Title or Position | DOCTOR
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Name | DAVID BERNARD ROY
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Credential | D.O.
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Telephone | 601-475-9968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 21178
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License Number State | MS
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