Individual
TIMOTHY P KERUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 HIGHWAY 61 N, VICKSBURG, MS 39183-8246
(601) 883-3320
Mailing address
104 MCAULEY DR, VICKSBURG, MS 39183-2825
(601) 638-7271
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
11047
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120441
—
MS
05
—
1546143
—
LA
01
—
5694020
AETNA
MS
Enumeration date
07/05/2006
Last updated
09/10/2020
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