Individual
MR. DALE P HOTARD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
103 FAIRVIEW DR, VICKSBURG, MS 39180-8934
(314) 258-1988
Mailing address
103 FAIRVIEW DR, VICKSBURG, MS 39180-8934
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
4045094
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
901422
MS
Other
Enumeration date
02/01/2017
Last updated
09/17/2025
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