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Individual

DR. KEVIN BRYAN CLEMENT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5630
(601) 268-5819
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5630
(601) 268-5819

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
00022961
AL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
16905
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00123076
MS
05
009935563
AL
01
1353817
CIGNA
MS
01
5750556
AETNA
MS
Enumeration date
06/22/2006
Last updated
07/02/2010
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