# DESOTO OSTEOPATHIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558382200
- **Authorized official:** MRS. DEBBIE CLARK (BILLER)
- **Authorized official phone:** (662) 429-5221

## Contact information

- **Practice address:** 187 STATELINE RD E, SUITE \#10, SOUTHAVEN, MS 38671-1704
- **Practice address phone:** (662) 342-5353
- **Practice address fax:** (662) 393-9753
- **Mailing address:** 187 STATELINE RD E, SUITE \#10, SOUTHAVEN, MS 38671-1704
- **Mailing address phone:** (662) 342-5353
- **Mailing address fax:** (662) 393-9753

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 15380 | MS | Yes |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 10/22/2007