Organization
ENT SURGICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE GORDON MD (OWNER)
(601) 898-7500
Entity
Organization
Contact information
Practice address
138 PARK PLACE BLVD, MADISON, MS 39110
(601) 898-7500
Mailing address
138 PARK PLACE BLVD, MADISON, MS 39110
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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