Individual
DEXTER W WALCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1513 LAKELAND DR., SUITE 101, JACKSON, MS 39216
(601) 354-4836
(601) 354-2619
Mailing address
1513 LAKELAND DR., SUITE 101, JACKSON, MS 39216
(601) 354-4836
(601) 354-2619
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
10031
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112408
—
MS
05
—
00113910
—
MS
Enumeration date
01/24/2006
Last updated
07/20/2009
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