Individual
DR. WIRT FLETCHER SHROCK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
630 NORTHWEST AVE, DURANT, MS 39063-3337
(662) 653-3012
(662) 653-6423
Mailing address
630 NORTHWEST AVE, DURANT, MS 39063-3337
(662) 653-3012
(662) 653-6423
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10738
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011270
—
MS
Enumeration date
10/11/2006
Last updated
02/15/2010
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