Organization
GARDEN PARK HOSPITALIST PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M. LAVERTY (VP)
(615) 507-2312
Entity
Organization
Contact information
Practice address
15200 COMMUNITY RD, 4TH FLOOR, GULFPORT, MS 39503-3085
(228) 575-7243
(801) 575-7420
Mailing address
15200 COMMUNITY RD, 4TH FLOOR, GULFPORT, MS 39503-3085
(228) 575-7243
(801) 575-7420
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07378761
—
MS
Enumeration date
09/27/2007
Last updated
05/13/2009
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