Individual
DR. DIMITRIOS J DIMITRIADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
394 COURTHOUSE RD, SUITE A, GULFPORT, MS 39507-1865
(228) 896-4417
(228) 604-0121
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 865-1453
(228) 868-8504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16024
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119666
—
MS
01
—
080119197
RAILROAD MEDICARE
MS
01
—
5057532
AETNA
MS
Enumeration date
06/24/2006
Last updated
07/10/2014
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