Individual
JIM ALFRED DELOACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330B HIGHWAY 90, GAUTIER, MS 39553-5744
(228) 497-0434
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
08/19/2022
Last updated
04/12/2026
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