Organization
VICKSBURG ALLERGY AND ASTHMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY KERUT MD (PRESIDENT)
(601) 636-0097
Entity
Organization
Contact information
Practice address
104 MCAULEY DR, VICKSBURG, MS 39183-2825
(601) 636-0097
(601) 629-9969
Mailing address
107 CARLTON PLACE DR, VICKSBURG, MS 39180-1822
(601) 636-0097
(601) 629-9969
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
11047
MS
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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