# PRIMARY CARE MEDICAL CENTER OF GULFPORT, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427271840
- **Authorized official:** MRS. ANGELA V MCCLURE (INSURANCE CLERK)
- **Authorized official phone:** (228) 832-9038

## Contact information

- **Practice address:** 15444 DEDEAUX RD, STE. B, GULFPORT, MS 39503-2637
- **Practice address phone:** (228) 832-9038
- **Practice address fax:** (228) 832-9990
- **Mailing address:** 15444 DEDEAUX RD, STE. B, GULFPORT, MS 39503-2637
- **Mailing address phone:** (228) 832-9038
- **Mailing address fax:** (228) 832-9990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2083X0100X | Occupational Medicine Physician | — | NULL | — |
| 2083X0100X | Occupational Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 04/11/2007
- **Last updated:** 07/13/2007