Organization
GULF COAST DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN A CRANE M.D. (PHYSICIAN)
(228) 868-4006
Entity
Organization
Contact information
Practice address
1304 44TH AVE, GULFPORT, MS 39501-2552
(228) 868-4006
(228) 868-9545
Mailing address
1304 44TH AVE, GULFPORT, MS 39501-2552
(228) 868-4006
(228) 868-9545
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
14316
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04922734
—
MS
01
—
070007893
MEDICARE RR
MS
Enumeration date
10/18/2005
Last updated
08/20/2009
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