Provider Demographics
NPI:1619976636
Name:RIMMER, DAVID MILLARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILLARD
Last Name:RIMMER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DRINKWATER RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST.LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1614
Mailing Address - Country:US
Mailing Address - Phone:228-463-8939
Mailing Address - Fax:228-463-8938
Practice Address - Street 1:202C DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1638
Practice Address - Country:US
Practice Address - Phone:228-463-8939
Practice Address - Fax:228-463-8938
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03504366Medicaid
MS20000509Medicare PIN
MSH20649Medicare UPIN
MS03504366Medicaid