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General NPI Number Information
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NPI Number | 1891833299
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Entity Type | Organization
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Legal Business Name | GULF COAST NEUROLOGY CENTER, PLLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 3631 BIENVILLE BLVD SUITE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5702
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Country | US
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Telephone | 228-818-9620
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Fax | 228-818-9750
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Provider Business Mailing Address
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Address Line | 3631 BIENVILLE BLVD SUITE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5702
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Country | US
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Telephone | 228-818-9620
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Fax | 228-818-9750
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LENNON E BOWEN IV
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Credential | M.D.
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Telephone | 228-818-9620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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