Provider Demographics
NPI:1487018420
Name:CASWELL, ELLEN DAUTERIVE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:DAUTERIVE
Last Name:CASWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CLAIRE
Other - Last Name:DAUTERIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-575-1194
Mailing Address - Fax:228-575-2917
Practice Address - Street 1:8950 LORRAINE RD STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4183
Practice Address - Country:US
Practice Address - Phone:228-822-6770
Practice Address - Fax:228-896-5374
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28955207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism