Provider Demographics
NPI:1417343559
Name:MARCELO, DENNIS RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RYAN
Last Name:MARCELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-9113
Mailing Address - Country:US
Mailing Address - Phone:855-343-5763
Mailing Address - Fax:
Practice Address - Street 1:7100 U S HIGHWAY 98 STE 210
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8557
Practice Address - Country:US
Practice Address - Phone:601-545-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS33695207LP2900X
CODR.0064172208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine