Individual
GREG ALLAN LASSITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
3110 B SEAGULL ST, GULFPORT, MS 39501
(228) 871-2810
Mailing address
5305 MARVIN SHIELDS BLVD, GULFPORT, MS 39501
(228) 871-2810
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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