Provider Demographics
NPI:1003397530
Name:THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI
Entity Type:Organization
Organization Name:THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DDS, MPH
Authorized Official - Phone:228-831-8764
Mailing Address - Street 1:19289 ST. JOSEPH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532
Mailing Address - Country:US
Mailing Address - Phone:228-831-8764
Mailing Address - Fax:228-233-1252
Practice Address - Street 1:19289 ST. JOSEPH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532
Practice Address - Country:US
Practice Address - Phone:228-831-8764
Practice Address - Fax:228-233-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty