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General NPI Number Information
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NPI Number | 1073248134
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Entity Type | Organization
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Legal Business Name | JAY J LIBYS MD PA
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4500 13TH ST
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City | GULFPORT
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State | MS
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Zip | 39501-2515
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Country | US
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Telephone | 228-822-6132
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Fax |
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Provider Business Mailing Address
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Address Line | 24654 OAK ISLAND DR
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-8142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | WILLIAM FULCHER
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Credential |
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Telephone | 601-918-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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