Provider Demographics
NPI:1851327555
Name:UTTERBACK, DAVID B (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:UTTERBACK
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 789
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0789
Mailing Address - Country:US
Mailing Address - Phone:228-872-9388
Mailing Address - Fax:
Practice Address - Street 1:351 COWAN RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2019
Practice Address - Country:US
Practice Address - Phone:228-896-1120
Practice Address - Fax:228-896-1332
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15753207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
49351Medicare UPIN