Individual
DR. ALTON HENRY DAUTERIVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACS
Contact information
Practice address
1340 BROAD AVE, SUITE 220, GULFPORT, MS 39501-2404
(228) 864-0092
(228) 867-6423
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 864-0092
(228) 867-6423
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
10998
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117914
—
MS
Enumeration date
03/07/2007
Last updated
07/10/2014
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