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Individual

DR. WALTER KASTLER GRANT III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
920 TOMMY MUNRO DR, BILOXI, MS 39532-2150
(228) 396-8101
(601) 496-8101
Mailing address
2500 NORTH STATE STREET, JMM SUITE 2525, JACKSON, MS 39216-4500
(601) 815-9528
(601) 984-6439

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
14991
MS
208000000X
Pediatrics Physician
29157
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00116939
MS
Enumeration date
08/20/2006
Last updated
04/06/2018
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