Individual
MR. WALTER EDWARD GIPSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1702 HWY 11 N, STE A, PICAYUNE, MS 39466
(601) 799-3130
(601) 799-3132
Mailing address
1702 A HWY 11 NORTH, PICAYUNE, MS 39466
(601) 799-3130
(601) 799-3132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13890
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112115
—
MS
01
—
640880384
BLUE CROSS
MS
Enumeration date
08/17/2006
Last updated
05/17/2017
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