DAVID B ROY DO PA (NPI# 1194124834) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194124834 |
| Entity Type | Organization |
| Organization Name | DAVID B ROY DO PA |
| Other Organization Name | PINE BELT DERMATOLOGY & SKIN CANCER CENTER |
| Practice Address |
201 S Main St Petal MS 39465-2362 |
| Practice Telephone | 3188849706 |
| Mailing Telephone | 3188849706 |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2015-01-29 |
| Authorized Official Name | JOY LYNN MOORE (OFFICE MANAGER) |
| Authorized Official Telephone | 5132673658 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
21178 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BC/BS OF MS | 595626050 | 01 |
| MS | 09537875 | 05 | |
| MS | GROUP NPI | 1194124834 | 01 |
| Other Name | Type Code |
|---|---|
| Pine Belt Dermatology & Skin Cancer Center | Doing Business As Name - Organization |
| Street Address |
201 S MAIN ST |
| City | PETAL |
| State | MS |
| Zip Code | 39465-2362 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578190443 | Raven Miller | Nurse Practitioner | 201 S Main St, Petal, MS 39465-2362 | 2020-03-23 |
| 1497159453 | Pine Belt Dermatology and Skin Cancer Center | Dermatology | 201 S Main St, Petal, MS 39465-2362 | 2014-10-20 |
| 1801097019 | David Bernard Roy | Dermatology | 201 S Main St, Petal, MS 39465-2362 | 2007-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164055489 | R&p Elite Services, LLC | Private Vehicle | 68 Springfield Rd., Petal, MS 39465 | 2020-02-14 |
| 1003460544 | Hayden White | Pharmacist | 36 Byrd Dr., Petal, MS 39465 | 2019-08-01 |
| 1134612971 | Chandler Mccarley Hawkins | Dentist | 1115 Evelyn Gandy Parkway, Petal, MS 39465 | 2018-06-06 |
| 1881199818 | Lauren O'neal Garner | Nurse Practitioner | 36 Stadium Drive, Petal, MS 39465 | 2018-03-30 |
| 1700036928 | Petal School District | Registered Nurse | 60 Herrington Road, Petal, MS 39465 | 2008-09-24 |
| 1962679043 | Hattiesburg Eye Clinic Pa | Optometrist | 1223 Hwy 42, Ste 140, Petal, MS 39465 | 2008-05-08 |
| 1023228640 | Noal Baxter Cochran | Marriage & Family Therapist | 80 Lakeland Circle, Petal, MS 39465 | 2007-05-23 |
| 1750596938 | James A Nicholson Dds Pa | Dentist | 120 South 28th Avenue, Hattiesburg, MS 39465 | 2007-05-11 |
| 1356563605 | Petal School District | Registered Nurse | 400 Hillcrest Loop, Petal, MS 39465 | 2007-05-03 |
| 1154480804 | Mary E Thomsen | Orthotic Fitter | 173 Cherry Oak Trail, Petal, MS 39465 | 2006-12-08 |
| Find all providers in zip 39465 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497159453 | Pine Belt Dermatology and Skin Cancer Center | Dermatology | 201 S Main St, Petal, MS 39465-2362 | 2014-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578583514 | Terry Westmoreland | Dermatology | 2110 5th St N, Columbus, MS 39705-2210 | 2006-07-20 |
| 1073828455 | South Central Clinics, Inc | Dermatology | 1410 Jefferson St, Laurel, MS 39440-4243 | 2010-08-10 |
| 1912166703 | William H Black | Dermatology | 2500 N State St, Jackson, MS 39216-4500 | 2008-06-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.