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General NPI Number Information
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NPI Number | 1619107778
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Entity Type | Organization
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Legal Business Name | ANCHOR MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 3613B HOSPITAL ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-4112
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Country | US
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Telephone | 228-769-9155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1206
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City | PASCAGOULA
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State | MS
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Zip | 39568-1206
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Country | US
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Telephone | 228-769-9155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN BYDALEK
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Credential | MD
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Telephone | 228-769-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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