Gautier, Kenneth Bryan

Gautier, Kenneth Bryan is an individual health care provider with primary practice located at 103 Halls Cv , Senatobia MS 38668-6620. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Gautier, Kenneth Bryan can be contacted via phone (662) 562-9003.

Contact Information

Primary practice address
103 Halls Cv Senatobia MS 38668-6620
Phone: (662) 562-9003
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 18615 Mississippi

Profile Details

NPI number 1467551465
LBN Legal business name Gautier, Kenneth Bryan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2006
Last updated Feb 29th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467551465 NPPES
Mississippi MEDICAID 06727534

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