Individual
GORDON W SLUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 N FRONTAGE RD, VICKSBURG, MS 39180
(601) 634-8790
Mailing address
2200 HIGHWAY 61 N, VICKSBURG, MS 39183-8246
(601) 883-4133
(601) 661-0985
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
09812
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013539
—
MS
05
—
1331287
—
LA
01
—
4627838
AETNA
MS
Enumeration date
06/30/2006
Last updated
07/12/2018
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