Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 08350 | MS |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 08350 | MS |
NPI | 1831150838 |
---|---|
Provider Name | Charles Edwin Guice III |
First Address | Hattiesburg, MS 39404-7829 |
Second Address | Hattiesburg, MS 39402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 12/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00015250 | (05) | MS |
D80489 | (02) |