Provider Demographics
NPI:1558379263
Name:PASSER, KEVIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:PASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6068 HIGHWAY 98 WEST
Mailing Address - Street 2:SUITE 1-255
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-261-9101
Mailing Address - Fax:601-261-9102
Practice Address - Street 1:5317-4 OLD HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-261-9101
Practice Address - Fax:601-261-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS139702084P0800X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine