Healthcare Provider Details

I. General information

NPI: 1811084171
Provider Name (Legal Business Name): ERIC H WOLFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD STREET SUITE 440
GULFPORT MS
39501
US

IV. Provider business mailing address

PO BOX 17708
HATTIESBURG MS
39404-7708
US

V. Phone/Fax

Practice location:
  • Phone: 228-865-3201
  • Fax: 228-575-1464
Mailing address:
  • Phone: 228-865-3201
  • Fax: 228-575-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number18381
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number18381
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: