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Technologists, Technicians & Other Technical Service Providers Technician, Other

Provider NPI: 1528360955

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
100 LAROSA RD.  LONG BEACH, MS 39560-4000 US
Tel: 228-863-8050  Fax: 228-863-1693

Business Mailing Address:
Tel: 251-653-1112  Fax: 251-653-3128

NPI Information:
NPI: 1528360955
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y247200000XTechnologists, Technicians & Other Technical Service Providers
Technician, Other

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 247200000X





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