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Contact Information

ALTON H DAUTERIVE, MD, FACS
1340 BROAD AVE
SUITE 220
GULFPORT, MS39501-2404
 Phone: 228-864-0092
 Fax: 228-867-6423
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for ALTON H DAUTERIVE · (Male)

NPI # 1558491589
Status Active
Credentials MD, FACS
Entity Individual
Enumeration date 03/07/2007
Last updated 07/10/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 10998
  • MS Medicaid 00117914
Hospital affiliation(s)
  • MEMORIAL HOSPITAL AT GULFPORT - (Acute Care)
    4500 13TH ST-P O BOX 1810
    GULFPORT, MS 39502
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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