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Organization
SOUTHERN UROLOGY ASSOCIATES LLC
Active
Organization
SOUTHERN UROLOGY ASSOCIATES LLC
Active
Other names
Southern Urology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J. LAGEESE (VP)
(504) 988-7044
Entity
Organization
Contact information
Practice address
15190 COMMUNITY RD, SUITE 260, GULFPORT, MS 39503-3485
(228) 539-0071
(228) 539-0722
Mailing address
15190 COMMUNITY RD, SUITE 260, GULFPORT, MS 39503-3485
(228) 539-0071
(228) 539-0722
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275576
—
MS
Enumeration date
06/12/2006
Last updated
06/21/2018
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