Individual
COLTON ANTHONY WEGRZYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
5501 MARVIN SHIELDS BLVD, GULFPORT, MS 39501-9007
(228) 822-5919
Mailing address
14755 AUDUBON LAKE BLVD, GULFPORT, MS 39503-6267
(224) 308-4478
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
08/15/2023
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