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Individual

DR. BRIAN THOMAS ANTHONY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
833 HIGHWAY 90 STE 1, BAY ST LOUIS, MS 39520-1601
(228) 575-2920
(228) 466-4677
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1194
(228) 575-2917

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14843
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00116990
MT
01
09015599
GROUP MEDICAID NUMBER: TAX ID 64-093424
MS
Enumeration date
07/12/2005
Last updated
04/14/2022
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