Holland J Pitre, MD
Individual provider Active NPI Dermatology Physician · Vicksburg, MS
NPI 1467418152 · NPPES record last updated Aug 30, 2013
Key facts
- NPI
- 1467418152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 12026 (LA)
- Practice address
- 1202 Mission Park Dr
1202 Mission Park Dr
Vicksburg, MS 39180-3758 - Phone
- (601) 415-6089
- Fax
- (601) 636-6677
- NPI assigned
- Apr 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12026 | LA | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duke Neal Medical, LLC | Dermatology | Past | Accepting new patients |
| P Mark Neal MD LLC | Past | Accepting new patients | |
| William Wilder, Apmc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 12026 | LA | Yes |
Addresses
Primary practice location
1202 Mission Park Dr
1202 Mission Park Dr
Vicksburg, MS 39180-3758
Mailing address
1202 Mission Park Dr
1202 Mission Park Dr
Vicksburg, MS 39180-3758
Phone (601) 415-6089
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1095303 | Medicaid | LA | |
| 3021079461 | Other | MS | PTAN |
Other providers in Vicksburg, MS
- Physical Therapy Occupational Therapy Speech Therapy
- Physician Management Services of Mississippi, LLC
- Physician Practice of Madison, PC
- Physicians Sleep Diagnostics, Inc
- Paul W Pierce IV
- Holly Pittman
- Sarah Grace Pittman
- Tamatha Polk-Henderson
- Madelyn Polk
- Traniecia Polk
All providers in Vicksburg, MS · Dermatology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.