Organization
GULF COAST PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC J WYBLE (OWNER MD)
(228) 865-7299
Entity
Organization
Contact information
Practice address
1133 45TH AVE, GULFPORT, MS 39501-2564
(228) 865-7299
Mailing address
PO BOX 366, GULFPORT, MS 39502-0366
(228) 865-7299
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
12046
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG9511
RAILROAD MEDICARE
MS
Enumeration date
02/22/2006
Last updated
10/30/2009
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