Organization
MO SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LANCE JOHANSEN M.D. (CEO)
(228) 328-2400
Entity
Organization
Contact information
Practice address
15190 COMMUNITY RD., SUITE 120, GULFPORT, MS 39503-3484
(228) 328-2400
(228) 328-4200
Mailing address
15190 COMMUNITY RD., SUITE 120, GULFPORT, MS 39503-3484
(228) 328-2400
(228) 328-4200
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04232510
—
MS
Enumeration date
03/13/2019
Last updated
03/13/2019
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