Organization
JAY J LIBYS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM FULCHER (MGR)
(601) 918-7301
Entity
Organization
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 822-6132
Mailing address
24654 OAK ISLAND DR, PASS CHRISTIAN, MS 39571-8142
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115535
—
MS
Enumeration date
07/21/2022
Last updated
07/21/2022
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