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General NPI Number Information
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NPI Number | 1477789964
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Entity Type | Organization
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Legal Business Name | LETONOFF ORTHOPAEDICS & SPORTS
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 452 COURT HOUSE ROAD SUITE G
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City | GULFPORT
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State | MS
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Zip | 39507
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Country | US
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Telephone | 228-896-4747
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Fax | 228-896-4740
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Provider Business Mailing Address
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Address Line | 452 COURT HOUSE ROAD SUITE G
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City | GULFPORT
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State | MS
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Zip | 39507
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Country | US
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Telephone | 228-896-4747
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Fax | 228-896-4740
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Authorized Official
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Title or Position | OWNER
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Name | ERIG J LETONOFF
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Credential | MD
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Telephone | 228-896-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 18468
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License Number State | MS
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