Provider Demographics
NPI:1912428590
Name:STAUFERT GUTIERREZ, DENISSE LETICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISSE
Middle Name:LETICIA
Last Name:STAUFERT GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENISSE
Other - Middle Name:
Other - Last Name:STAUFERT-GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:504 CLINTON CENTER DR STE 4300
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-984-1000
Mailing Address - Fax:601-815-2005
Practice Address - Street 1:4400 OLD CANTON RD FL 3
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5982
Practice Address - Country:US
Practice Address - Phone:888-815-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS310162080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics