Individual
DEWITT L BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
906 SIXTH AVE, PICAYUNE, MS 39466-3802
(601) 798-7529
(601) 798-7553
Mailing address
906 SIXTH AVE, PICAYUNE, MS 39466-3802
(601) 798-7529
(601) 798-7553
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05036
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00011789
—
MS
Enumeration date
08/04/2006
Last updated
07/08/2007
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