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Organization
DESOTO OSTEOPATHIC
Active
Organization
DESOTO OSTEOPATHIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIE CLARK (BILLER)
(662) 429-5221
Entity
Organization
Contact information
Practice address
187 STATELINE RD E, SUITE #10, SOUTHAVEN, MS 38671-1704
(662) 342-5353
(662) 393-9753
Mailing address
187 STATELINE RD E, SUITE #10, SOUTHAVEN, MS 38671-1704
(662) 342-5353
(662) 393-9753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15380
MS
Other
Enumeration date
07/21/2006
Last updated
10/22/2007
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