Individual
MS. DEDRI MARKITA IVORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3510 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5506
(601) 501-6991
(601) 501-6987
Mailing address
3510 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5506
(601) 501-6991
(601) 501-6987
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
21520
MS
390200000X
Student in an Organized Health Care Education/Training Program
2009009253
MO
390200000X
Student in an Organized Health Care Education/Training Program
57.011968
OH
Other
Enumeration date
08/30/2007
Last updated
01/13/2017
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