Individual
MR. WALTER M GORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 CHURCH ST, BELZONI, MS 39038-3929
(662) 247-2105
(662) 247-4849
Mailing address
PO BOX 633, BELZONI, MS 39038-0633
(662) 247-2105
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05613
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14079
—
MS
Enumeration date
03/16/2006
Last updated
08/17/2010
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