Individual
MR. HOLLAND J PITRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1202 MISSION PARK DR, 1202 MISSION PARK DR, VICKSBURG, MS 39180-3758
(601) 415-6089
(601) 636-6677
Mailing address
1202 MISSION PARK DR, 1202 MISSION PARK DR, VICKSBURG, MS 39180-3758
(601) 415-6089
(601) 636-6677
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12026
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1095303
—
LA
01
—
3021079461
PTAN
MS
Enumeration date
04/22/2006
Last updated
08/30/2013
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