Provider Demographics
NPI:1720164916
Name:DOSTER, VERNON W (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:W
Last Name:DOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:3616 HOSPITAL STREET SUITE D
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39568-1323
Mailing Address - Country:US
Mailing Address - Phone:228-762-8187
Mailing Address - Fax:228-762-6934
Practice Address - Street 1:3616 HOSPITAL STREET
Practice Address - Street 2:SUITE D
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581
Practice Address - Country:US
Practice Address - Phone:228-762-8187
Practice Address - Fax:228-762-6934
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS08184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS010000399Medicare ID - Type Unspecified
MSD80527Medicare UPIN