Basic Information
| Provider Information | |||||||||
| NPI: | 1932259546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMETROPOULOS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | GAUTIER | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395535340 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3099 BIENVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395644308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288722403 | ||||||||
| FaxNumber: | 2288724027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MS11472 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | MS11472 | MS | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 646000515 | 01 | BLUE CROSS OF MS | OTHER | 646000515 | 01 | TRICARE | OTHER | 930026706 | 01 | RAILROAD MEDICARE | OTHER | 00014926 | 05 | MS | MEDICAID | 00017926 | 05 | MS | MEDICAID | 385908YKC0 | 01 | MS | MEDICARE | OTHER | 008906770 | 05 | AL | MEDICAID |