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General NPI Number Information
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NPI Number | 1043434566
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Entity Type | Organization
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Legal Business Name | GULF COAST ENDOCRINOLOGY
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4540 W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-2480
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Country | US
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Telephone | 228-867-6062
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Fax | 228-867-2598
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Provider Business Mailing Address
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Address Line | 4540 W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-2480
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Country | US
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Telephone | 228-867-6062
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Fax | 228-867-2598
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Authorized Official
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Title or Position | OWNER
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Name | DR. BEVERLY LANSDEN
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Credential | M.D.
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Telephone | 228-867-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | MS
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