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General NPI Number Information
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NPI Number | 1336259100
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Entity Type | Organization
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Legal Business Name | GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, PLLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 4509 GIBSON RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-6026
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Country | US
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Telephone | 228-872-3993
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Fax | 228-872-3992
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Provider Business Mailing Address
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Address Line | 4509 GIBSON RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-6026
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Country | US
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Telephone | 228-872-3993
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Fax | 228-872-3992
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Authorized Official
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Title or Position | BILLING
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Name | JIMMIE G RICHMOND
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Credential |
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Telephone | 228-872-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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