Healthcare Provider Details

I. General information

NPI: 1437398260
Provider Name (Legal Business Name): GULFPORT EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MARION AVE
MCCOMB MS
39648-2705
US

IV. Provider business mailing address

PO BOX 13647
PHILADELPHIA PA
19101-3647
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-1180
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES L. MURPHY
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 214-712-2000