Individual
MARK A DELOACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16 S SIXTH ST, BAY SPRINGS, MS 39422-9055
(601) 764-4501
(601) 764-2310
Mailing address
PO BOX 723, BAY SPRINGS, MS 39422-0723
(601) 340-3544
(601) 651-2926
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14545
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
822838
WELLCARE
—
Enumeration date
08/28/2006
Last updated
07/21/2022
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