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General NPI Number Information
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NPI Number | 1215265939
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Entity Type | Organization
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Legal Business Name | VASCULAR SPECIALISTS OF MOBILE, P.C.
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 90 INDUSTRIAL PARK CIR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5800
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Country | US
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Telephone | 228-327-5225
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Fax |
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Provider Business Mailing Address
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Address Line | 171 MOBILE INFIRMARY BLVD
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City | MOBILE
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State | AL
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Zip | 36607-3509
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Country | US
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Telephone | 251-432-0558
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Fax | 251-432-0554
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Authorized Official
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Title or Position | OWNER
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Name | GLENN ELLIOTT ESSES
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Credential | M.D.
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Telephone | 251-432-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 20777
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License Number State | MS
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