Individual
DR. CALVIN S ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8006 HWY 613, MOSS POINT, MS 39562
(228) 475-1166
(228) 475-9337
Mailing address
PO BOX 1358, ESCATAWPA, MS 39552-1358
(228) 475-1166
(228) 475-9337
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
08202
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115468
—
MS
Enumeration date
09/22/2006
Last updated
07/08/2007
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