Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Other names
Internal Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
1110 BROAD AVE, SUITE 700, GULFPORT, MS 39501-8907
(228) 864-0314
(228) 864-0425
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014379
—
MS
Enumeration date
06/22/2006
Last updated
04/02/2008
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