Provider Demographics
NPI:1073724910
Name:DARE, PAUL FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FREDERIC
Last Name:DARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 HUNTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-8791
Mailing Address - Country:US
Mailing Address - Phone:601-831-6202
Mailing Address - Fax:
Practice Address - Street 1:1151 NORTH STATE ST., SUITE 311
Practice Address - Street 2:JACKSON ANESTHESIA ASSOCIATES
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:210-567-4500
Practice Address - Fax:210-567-0083
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22769207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology