Provider Demographics
NPI:1730168618
Name:TEMPLE, DARRYL (FNP)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-1909
Mailing Address - Country:US
Mailing Address - Phone:601-250-1122
Mailing Address - Fax:601-250-0290
Practice Address - Street 1:1017 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3827
Practice Address - Country:US
Practice Address - Phone:601-250-1122
Practice Address - Fax:601-250-0290
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852966207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00342599OtherMEDICARE RAILROAD
MS1730168618Medicare NSC
MSP00342599OtherMEDICARE RAILROAD